Parathyroid Surgery

Understanding Hyperparathyroidism: Causes, Symptoms, and Treatment

Hyperparathyroidism is a medical condition that occurs when one or more of the parathyroid glands become overactive and secrete too much parathyroid hormone (PTH). PTH plays a crucial role in regulating calcium, phosphorus, and vitamin D levels in the body. An excess of this hormone can lead to several health problems, particularly involving the bones, kidneys, and digestive system.

The Parathyroid Glands: An Overview

The parathyroid glands are four small, pea-shaped glands located near the thyroid gland in the neck. Despite their size, these glands have a significant role in maintaining calcium balance in the body. Calcium is vital for muscle function, nerve transmission, blood clotting, and bone health.

The parathyroid glands release PTH to regulate calcium levels in the blood. When calcium levels are low, PTH is released to increase calcium levels by promoting calcium release from bones, increasing calcium absorption from the intestines, and enhancing calcium reabsorption by the kidneys. When calcium levels are high, the parathyroid glands reduce PTH production.

What is Hyperparathyroidism?

Hyperparathyroidism occurs when the parathyroid glands produce too much PTH, disrupting the balance of calcium in the blood. This results in elevated calcium levels, a condition known as hypercalcemia. Hypercalcemia can lead to various complications if not treated properly.

There are three main types of hyperparathyroidism:

1. Primary Hyperparathyroidism: The most common form, primary hyperparathyroidism occurs when one or more of the parathyroid glands becomes enlarged (usually a benign tumor, called an adenoma), leading to excessive PTH production. In rare cases, hyperparathyroidism can result from hyperplasia (an increase in the number of cells) or, very rarely, parathyroid cancer.
2. Secondary Hyperparathyroidism: This occurs as a result of another underlying condition, typically kidney disease, where the kidneys cannot properly regulate calcium levels. The body responds by increasing PTH production to try to correct low calcium levels, even though this overproduction can worsen the problem.
3. Tertiary Hyperparathyroidism: This is a long-term complication of secondary hyperparathyroidism, most commonly in individuals with chronic kidney disease. Over time, the parathyroid glands become autonomously overactive, continuing to produce excess PTH despite treatment of the underlying cause.

Symptoms of Hyperparathyroidism

The symptoms of hyperparathyroidism can vary, and many people with mild forms of the condition may not show any signs at all. When symptoms do occur, they are often related to the effects of high calcium levels. Common symptoms include:

• Fatigue or weakness
• Bone pain and fractures
• Kidney stones (due to excessive calcium)
• Abdominal pain and nausea
• Frequent urination
• Mental fog or confusion
• Depression or anxiety
• Loss of appetite

In severe cases, untreated hyperparathyroidism can lead to osteoporosis (weakened bones), kidney failure, and cardiovascular issues.

Diagnosis

To diagnose hyperparathyroidism, doctors typically perform a series of tests:

• Blood Tests: The key diagnostic test involves measuring calcium and PTH levels. High calcium levels and elevated PTH are indicative of hyperparathyroidism.
• Urine Tests: These can help assess how much calcium is being excreted in the urine, which can indicate kidney function.
• Imaging Tests: In some cases, imaging tests like ultrasounds, CT scans, or sestamibi scans are used to identify abnormalities in the parathyroid glands, such as tumors or enlargement.

Treatment Options

Treatment for hyperparathyroidism depends on the type and severity of the condition, as well as the underlying cause. The main treatment options include:

1. Surgical Removal (Parathyroidectomy): The most common treatment for primary hyperparathyroidism is the surgical removal of the overactive parathyroid gland or glands. In cases where only one gland is affected, the procedure typically resolves the condition. However, the adenoma is usually small and its location is often variable. Your endocrine surgeon can offer a focused parathyroidectomy using a small incision if the parathyroid adenoma is localised pre-operatively. It is therefore important to find an endocrine surgeon with experience in parathyroid surgery to ensure a high success rate for identifying the diseased parathyroid.
2. Medication: In some cases, medications may be used to manage symptoms or to prevent complications:
   • Bisphosphonates (to protect bone health)
   • Calcimimetics (to lower PTH levels)
   • Estrogen or selective estrogen receptor modulators (SERMs) for postmenopausal women to help with bone density.
3. Management of Underlying Conditions: For secondary hyperparathyroidism, the treatment focuses on addressing the underlying cause, such as improving kidney function or managing vitamin D deficiencies.
4. Dietary Changes and Supplements: Ensuring adequate calcium and vitamin D levels through diet and supplements may be important, especially for those with secondary hyperparathyroidism.
5. Monitoring: In cases where surgery is not appropriate, regular monitoring of calcium and PTH levels may be recommended, along with medications to manage the condition.

Prognosis

With early diagnosis and appropriate treatment, most people with hyperparathyroidism can lead healthy lives. However, if left untreated, hyperparathyroidism can lead to serious complications, such as bone thinning, kidney damage, and even cardiovascular problems. Surgery to remove the affected parathyroid gland(s) can often completely cure primary hyperparathyroidism, and most people experience significant improvement in symptoms after treatment.

Conclusion

Hyperparathyroidism is a condition that can affect multiple systems in the body, but with timely diagnosis and treatment, the impact can be minimized. If you experience symptoms such as fatigue, bone pain, kidney stones, or mental confusion, it’s important to consult a healthcare provider for proper evaluation. Early detection and management can prevent long-term complications and improve quality of life for those affected by this condition.