The most common parathyroid disease is hyperparathyroidism, which is the over-production of parathyroid hormone. Hyperparathyroidism occurs when at least one of your four parathyroid glands grows into a benign (non-cancerous) tumor and makes excess parathyroid hormone, whether you need it or not.
Referred to as a parathyroid adenoma, your enlarged parathyroid gland is hardly ever cancerous. However, because it induces an abnormally high level of calcium in your blood, it can slowly destroy a number of tissues in your body.
Parathyroid adenomas are typically much bigger than a normal parathyroid gland. Your parathyroid gland is normally the size of a grain of rice. A parathyroid adenoma, however, is often the size of a walnut. Most people with hyperparathyroidism also have a tumor in their neck about this size, which usually continues to grow until it is removed.
Hyperparathyroidism can cause a range of problems, such as kidney stones, pancreatitis, bone mineral loss, decreased kidney function, duodenal ulcer, itching, and muscle weakness. Patients with very high calcium levels may develop behavioral and mental changes, as well as life-threatening disturbances in the electrical activity of the heart.
Causes of Hyperparathyroidism
In most cases nobody knows what causes a tumor to develop in a parathyroid gland. Something happens within your parathyroid gland to cause the cells to replicate over and over until the gland grows into a tumor.
Some rare causes of tumor development are:
- Lithium. People who take Lithium on a daily basis for 10 or more years may develop parathyroid problems.
- Radioactive iodine therapy. Radioactive iodine therapy for previous thyroid problems causes approximately three percent of all parathyroid problems.
- Radiation therapy. Radiation treatments to the head, neck, and face as a child or teenager account for one to two percent of all parathyroid patients.
- Family history. Hereditary forms of hyperparathyroidism account for about two percent of all parathyroid patients.
- Kidney failure. Secondary hyperparathyroidism occurs in patients who have renal failure, and almost always in patients who have been on kidney dialysis for several years.
A small number of patients will have two parathyroid adenomas while having two normal parathyroid glands. An even smaller number of patients will have an enlargement of all four parathyroid glands, called parathyroid hyperplasia. This is much less common but the effects on your body are identical.
Signs and Symptoms of Hyperparathyroidism
Although few people with hyperparathyroidism say they have symptoms at the time of diagnosis, almost all say they feel better after treatment. Signs and symptoms of hyperparathyroidism include:
- Loss of energy
- Difficulty concentrating
- Difficulty sleeping (waking up in the middle of night or trouble falling asleep)
- Bones ache (typically in your arms and legs, but it can be almost anywhere)
- Osteoporosis and osteopenia
- Heartburn/gastric acid reflux (GERD)
- Decreased sex drive
- Thinning hair (predominately in older women)
- Kidney stones
- High blood pressure
- Recurrent headaches (usually in patients under age 40)
- Heart palpitations (arrhythmias)
Most people with hyperparathyroidism have at least three of these symptoms, and many have four to six. In general, the longer you have hyperparathyroidism, the more symptoms you will experience. The severity and type of symptoms, however, are not related to your calcium levels.
Parathyroid disease occurs much more frequently in women than men, and the average age at diagnosis is about 60 years old. Although people of any age can get parathyroid disease, it is rare in young people.
Diagnosis of Hyperparathyroidism
Many people with hyperparathyroidism have no symptoms. Their hyperparathyroidism is often discovered accidentally when blood tests are conducted for another reason.
To diagnose hyperparathyroidism, your doctor will first measure the amount of calcium in your blood. Tests for phosphorous and parathyroid hormone levels will help confirm whether you have a parathyroid disorder and rule out other potential causes of increased calcium levels.
Other tests include:
- Bone density exam
- Kidney x-rays (may show kidney stones)
- MRI or sestamibi neck scan, which may show swelling of your parathyroid glands
- Neck ultrasound
- Kidney ultrasound or CT scan, which may show kidney stones
- Urine test to check for increased calcium in your urine
Treatments for Hyperparathyroidism
Although medications can quickly lower life-threatening calcium levels, their efficacy is short-lived. Surgery to remove the tumor is required for long-term control of hyperparathyroidism. This surgery can be performed through a very small incision. Mount Sinai head and neck anesthesiologists generally administer a local anesthetic, allowing you to be comfortable during the procedure and go home the same day.
If you have a mild form of primary hyperparathyroidism, your physician might decide against surgery. Much of this management style stems from the fact that standard parathyroid surgery used to require general anesthesia and was a major operation. Now, parathyroid operations are not as involved as they once were, and you typically go home within a couple hours of the operation.
Surgical removal of your parathyroid tumor is the only way to treat parathyroid disease. There are no medications or pills to cure it.
- Standard parathyroid surgery. The standard parathyroid operation begins with an anesthesiologist putting you to sleep under general anesthesia. Your surgeon then makes an incision in your neck, retracts the muscles of your neck sideways, and loosens up and moves aside the thyroid gland to see your four parathyroid glands. These glands reside moderately deep within your neck, behind your thyroid. You will remain in the hospital overnight, and sometimes as long as two or three days. Your incision will generally be six to seven inches long. It should heal nicely but will leave a permanent scar on your neck.
- Minimal parathyroid surgery. Minimal parathyroid surgery (radio-guided parathyroid surgery) is dramatically changing the way surgeons treat parathyroid disease. This surgery usually takes less than 20 minutes and leaves a one- to two-inch scar. Minimal surgery:
- Has the highest cure rate of all parathyroid operations
- Has the lowest complication rate of all parathyroid operations
- Requires the smallest incision and the least amount of dissection
- Can be performed under light anesthesia
- Requires the least amount of time in the hospital
Patients with diseases of the thyroid and parathyroid come to the Mount Sinai Health System in New York City from all over the world. We provide comprehensive state-of-the-art care based on the latest innovations in the field. Our surgeons are internationally recognized as experts who excel in clinical care and research.