Parathyroid disease

Most people have 4 parathyroid glands located next to the thyroid gland. While they are close to the thyroid, they are unrelated in function. These small glands are responsible for regulating calcium in the bloodstream by producing parathyroid hormone (PTH).

An increase in PTH in the body causes the blood calcium levels to rise and less PTH causes the calcium levels to drop. PTH acts on the bones, kidneys and digestive tract.

The most common parathyroid disease is hyperparathyroidism, typically caused by a benign overgrowth of one of the parathyroid glands, called an adenoma. In some cases, multiple parathyroid glands can be abnormal and produce too much PTH. This typically causes abnormally high calcium levels in the blood. When the calcium level and the PTH are elevated, this is usually an issue with the glands and is known as primary hyperparathyroidism.

There are many other things that can cause an elevation of PTH that are not related to the glands themselves and collectively are known as secondary hyperparathyroidism. Common causes are vitamin D deficiency, low calcium intake/poor calcium absorption or kidney disease. Sometimes differentiating between primary and secondary hyperparathyroidism can be difficult and requires a combination of lab work, urine studies and imaging.

Very rarely one of these tumors is malignant. In those cases, the patient would need cancer treatment. Hypoparathyroidism is a type of parathyroid disease where too little PTH is produced, causing the calcium level in the blood to be low. This is less common and is typically after thyroid or parathyroid surgery.

The symptoms from hyperparathyroidism are typically from the effects of a high calcium level and not from PTH. The most common symptoms are fatigue, brain fog and a general sense of not feeling well. Other symptoms include:

• Bone pain and muscle pain (usually all over or migrating)
• Constipation
• Depression and anxiety
• Insomnia
• Muscle weakness

Due to the impact on the kidneys and bones, long-term consequences of untreated primary hyperparathyroidism can include decrease in bone density (osteopenia or osteoporosis), which can lead to bone fractures. It can also cause kidney stones and worsening kidney function due to an increase in excretion of calcium in the urine. Women are more likely than men to develop parathyroid disease, especially women over 50. It is also possible to have genetic factors that may make you higher risk for parathyroid disease.

Doctors use bloodwork to diagnose parathyroid disease. First, they will look at the parathyroid hormone (PTH) level and then will draw a metabolic panel with total calcium and vitamin D.

If the bloodwork indicates parathyroid disease, they will order imaging, like an ultrasound or CT scan, to determine which parathyroid gland is affected. The imaging study is essential for your care team to prepare for surgery.

Surgery, called a parathyroidectomy, is the mainstay of treatment for primary hypoparathyroidism, but it is not always needed if the condition is mild. The surgeon will remove the overactive parathyroid gland or glands. There are also medications that can be prescribed to treat your calcium levels if surgery is too risky or not an option. Patients under 50 with this diagnosis are recommended to have surgery regardless of symptoms due to long-term risks associated with untreated hyperparathyroidism.

As part of an academic medical center, you have access to the most advanced treatments and specialists who treat parathyroid disease, including endocrinologists and ear, nose and throat specialists. These teams are regularly recognized by U.S. News & World Report as among the nation's best. Our doctors work together to deliver personalized, comprehensive care for every patient.

Our surgeons use intraoperative PTH monitoring and advanced preoperative imaging techniques to deliver the best care for you.