Hyperparathyroidism is an excess of parathyroid hormone in the bloodstream due to overactivity of one or more of the body's four parathyroid glands. These glands are about the size of a grain of rice and are located in your neck.The parathyroid glands produce parathyroid hormone, which helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.Two types of hyperparathyroidism exist. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone, resulting in high levels of calcium in the blood (hypercalcemia), which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.Secondary hyperparathyroidism occurs as a result of another disease that initially causes low levels of calcium in the body and over time, increased parathyroid hormone levels occur.
The only 2 choices available for patients with primary hyperparathyroidism are to simply do nothing or to have the diseased parathyroid gland (or infrequently, more than one diseased parathyroid gland) surgically removed. Some physicians will elect to not refer their patients for an operation if they have a mild form of primary hyperparathyroidism.Much of this management style stems from the fact that standard parathyroid surgery in the past required the use of general anesthesia and was a major operation. But it's important to understand that parathyroid disease will get worse. It won't go away on its own. Remember, it is caused by a tumor that has developed from one of the parathyroid glands. Waiting will just allow the parathyroid tumor to grow bigger.Your age should also not be a reason to forego surgery. The new minimally invasive parathyroidectomy techniques have been performed on patients of many ages. The procedure uses local anesthesia that sends patients home in a matter of hours. To learn more, read our article about minimally invasive parathyroid surgery.
The initial random unilateral exploration was followed by trials to achieve a more guided unilateral exploration. Different adjuncts developed can be classified as preoperative (isotope scanning, ultrasonography, computer tomographic scanning) and intraoperative (intraoperative intact parathyroid hormone measurement, intraoperative 99mTc sestamibi scanning). The surgical techniques using these adjuncts range from a classic collar type incision followed by a unilateral exploration, over external exploration (unilateral or bilateral) through a very small incision, to endoscopic neck exploration. Reported outcomes of these techniques are presented, and all aspects mentioned are labeled as T-1 (preoperative), T0 (intraoperative), or T + 1 (results and complications) features. The reported results seem to indicate there is a place for a less invasive approach, but should be interpreted with caution seeing the ever present selection bias in the described population.The incidence of the disease is from about 1 in 500 to 1 in 1000. The majority of individuals affected by primary hyperparathyroidism are older women. In most patients, hypercalcemia isdiscovered when serum calcium is measured as a screening test.