Parathyroid glands are four small glands of the endocrine system that regulate the calcium in our bodies. Parathyroid glands are located in the neck behind the thyroid where they continuously regulate and monitor blood calcium levels.
Role of Parathyroid Glands
Parathyroid glands control the calcium levels in our blood, bones and throughout our body. They regulate the calcium by producing a hormone known as Parathyroid Hormone (PTH). Calcium is a very important element in our bodies as we use it to control many organ systems, hence the need to regulate it more carefully than any other element. In fact, calcium is the only element in our bodies with its own regulatory system – the parathyroid glands.
Parathyroid glands are normally the size of a grain of rice. But they can occasionally be as large as a pea and still be normal.
The single major disease of the parathyroid glands is over-activity of one or more of the parathyroid glands making too much parathyroid hormone leading to a potentially serious calcium imbalance (too high calcium in the blood). This is known as Hyperparathyroidism.
Hyperparathyroidism
Hyperparathyroidism is a condition that occurs when the parathyroid glands make too much parathyroid hormone (PTH). The parathyroid glands are four rice or pea-sized endocrine glands located in the neck, attached or near to the back of your thyroid. Endocrine glands secrete hormones which are necessary for the normal functioning of the body.
The parathyroid glands and the thyroid glands are very different organs despite being adjacent in your neck and having similar names. PTH helps to regulate the levels of calcium, phosphorus and vitamin D in your bones and blood.
Some individuals with this condition do not experience any symptoms and therefore do not need treatment. Others can have mild or severe symptoms that might require surgery.
Types of Hyperparathyroidism
There are three types of hyperparathyroidism:
- Primary
- Secondary
- Tertiary
Primary Hyperparathyroidism
This type occurs when you a problem with at least one of the parathyroid glands. Common causes of parathyroid problems include enlargement of at least one or two glands and benign growths on the gland. In rare cases, a cancerous tumour can cause this condition.
An increased risk of developing primary hyperparathyroidism can also occur in people who:
- Have certain genetic disorders that can affect several glands throughout the body, such as multiple endocrine neoplasia
- Have a long history of Vitamin D and calcium deficiencies
- Have been exposed to radiation from cancer treatment
- Have taken a drug known as lithium, which mainly treats bipolar disorder
Secondary Hyperparathyroidism
This type occurs when you have an underlying condition that can cause your calcium levels to be abnormally low. Most cases of secondary hyperparathyroidism are due to chronic kidney failure that results in low calcium and vitamin D levels.
Tertiary Hyperparathyroidism
This type occurs when the parathyroid glands keep making too much PTH after your calcium levels return to normal. It usually occurs in people with kidney problems.
Causes of Hyperparathyroidism
In hyperparathyroidism, usually one or more of the parathyroid glands become overactive and makes excess PTH. This could be due to gland enlargement, a tumour or other structural issues of the parathyroid glands.
When your calcium levels become too low, your parathyroid glands respond by increasing the PTH production. This causes your intestines and kidneys to absorb a larger amount of calcium. It also removes more calcium from your bones. The PTH production goes back to normal when your calcium level goes up again.
Symptoms of Hyperparathyroidism
The symptoms usually vary from mild to severe, depending on your type of hyperparathyroidism.
- Primary hyperparathyroidism: Some patients do not have any symptoms and if someone does have the symptoms, they can range from mild to severe. The mild symptoms include:
- Fatigue
- Weakness
- Depression
- Body aches
The severe symptoms include:
- Appetite loss
- Constipation
- Nausea
- Vomiting
- Excessive thirst
- Increased urination
- Confusion
- Memory problems
- Kidney stones
- Secondary hyperparathyroidism: With this type, you may have skeletal abnormalities such as swollen joints, fractures and bone deformities. Other symptoms depend on the underlying cause, such as severe vitamin D deficiency or chronic kidney failure.
Hyperparathyroidism Diagnosis
If your routine blood tests show high levels of calcium in your blood, your doctor might suspect hyperparathyroidism. Other tests will be performed to confirm the diagnosis and they include:
- Blood tests. This help in making a more accurate diagnosis. Your blood is checked for high PTH levels, high alkaline phosphatase levels and low levels of phosphorus.
- Urine tests. A urine test can help in determining how severe your condition is and whether kidney problems are the cause.
- Kidney tests. X-ray of your abdomen is taken to check for kidney abnormalities.
Treatment for Hyperparathyroidism
Primary Hyperthyroidism
You may not need treatment if your calcium levels are only slightly high, your kidneys are working fine or your bone density is normal. In this case, your doctor will monitor your condition once a year and check your blood-calcium levels twice a year. You’ll also need to take plenty of water to reduce your risk of kidney stones and get regular exercise to strengthen your bones.
- Surgery: In cases where treatment is necessary, surgery can be considered. The enlarged parathyroid glands or tumours on the gland can be surgically removed.
- Calcimimetics: These act like calcium in the blood and are another form of treatment. These drugs trick the glands into making less PTH. Doctors usually prescribe these in some of the cases where surgery is unsuccessful or not an option.
- Bisphosphonates: These keep the bones from losing calcium and can also help reduce the risk of osteoporosis.
- Hormone replacement therapy: This can help your bones to hold on to calcium. This therapy is mostly used to treat postmenopausal women with osteoporosis, but there are risks involved with prolonged use such as cancers and cardiovascular disease.
Secondary Hyperparathyroidism
Treatment for secondary hyperparathyroidism involves bringing the PTH level back to normal by treating the underlying cause. Treatment methods include taking prescription vitamin D for severe deficiencies and calcium and vitamin D for chronic kidney failure. If you have kidney failure, you might also need medication for it and dialysis.
Next Step
At King’s College Hospital Dubai, we focus on offering an exemplary service from initial consultation through to the final diagnosis and treatment and beyond. Our team of expert doctors and nurses are here to offer tailored management and treatment of your condition, and to answer any questions that you might have throughout your time with us. Whatever you need us for, we’re only a phone-call away.
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