The parathyroid glands are four tiny glands located in the neck behind the thyroid gland.
They produce parathyroid hormone which controls the calcium level in the body.
What is Hyperparathyroidism?
Most people have 4 parathyroid glands in their neck. The parathyroid glands regulate the amount of calcium in the body. If one or more of these glands becomes overactive, hyperparathyroidism develops. It occurs in approximately 1 in 10,000 people. It commonly affects middle-aged women. The cause is not yet known. However, it can sometimes run in families. It causes increased calcium in the blood and urine which can lead to osteoporosis and kidney stones.
- muscle/bone aches and pains
- passing excess urine (especially at night)
- poor concentration
- memory loss
Hyperparathyroidism can cause a change in personality and a patient may suffer from depression as a result.
In some cases, there may not be any symptoms and the condition is diagnosed incidentally via a routine blood test.
It can cause damage to other organs, in particular the kidneys (causing stones and kidney failure), and the bones (osteoporosis).
The calcium level can be temporarily lowered with intravenous fluid and drugs.
The only permanent cure however is surgery (Parathyroidectomy).
If you have one or more of the following surgery should be considered :
- raised calcium 0.25mM above normal
- end-organ disease
- aged under 60 years
Scans are required to identify which of the 4 glands is involved. An ultrasound scan detects enlargement of the parathyroids and a nuclear medicine scan identifies overactivity of the glands.
As well as blood tests, a 24 hour urine collection to measure the calcium level is required. Some patients will also need a scan of the kidneys looking for kidney stones and bone density scanning to exclude osteoporosis. This is known as a DEXA bone scan.
If an enlarged, overactive gland is identified, surgery can be performed through a small incision (Minimally Invasive Parathyroidectomy). This is usually carried out under general anaesthetic as a day case. In older patients who are too frail to tolerate a general anaesthetic, the procedure can be performed under local anaesthetic.