What is Hyperparathyroidism?
Maintaining a normal calcium level is important for various functions of the human body. Our bones serve as the main reservoir of calcium in the body. Our parathyroid glands act as the major overseer of calcium balance to keep its level in a very specific range for bone and general health. Hyperparathyroidism is an excess production of parathyroid hormone (PTH) from these glands. Over-production of parathyroid hormone can be from a benign parathyroid growth, or from overgrowth of all four glands. This results in bone loss, and disrupts the balance of many organ systems.
Symptoms of hyperparathyroidism usually reflect the effects of excess parathyroid hormone (PTH) leeching too much calcium from bone and raising the levels of calcium in the bloodstream, disrupting a delicate equilibrium. The higher calcium serum level can then:
- Drive acid production in the stomach and cause irritation of the stomach and GI tract
- Cause excess calcium to be filtered by the kidneys - increased urine calcium can lead to kidney stone formation
- Deplete calcium from bone leading to osteoporosis and fractures
- Lead to fatigue and joint complaints
- Interfere with brain processes, leading to mental sluggishness, memory problems, and mood and sleep disturbances
In most patients, the diagnosis is made on routine blood tests, when calcium and parathyroid levels are only slightly affected, and symptoms are mild or even non-existent.
The average person with this disease is more likely to be a woman just past middle age. Men are 2-3 times less likely than women to be affected. There is redundancy in the body’s ability to produce this hormone, in that we have 4 small glands located around (para) the thyroid and that’s how they got their name. Usually, only 1 of these 4 small glands is the overproducer and it is the doctor’s job to find the small culprit.
Since symptoms are usually mild or nonexistent, most patients are diagnosed by screening tests we commonly use. Many people are found to have a high calcium level by health fair lab tests or routine blood work at a primary care doctor’s office. These days, many women have a bone density test coinciding with their routine mammogram. A loss of bone density may prompt additional testing and lead to the diagnosis of hyperparathyroidism.
Verification of the diagnosis comes from other supportive lab tests, including a measure of parathyroid hormone (PTH). It is also important to ensure that there are not other causes of a high calcium level, such as cancer or autoimmune diseases. Once the diagnosis is confirmed by lab tests, finding the small culprit parathyroid gland may require certain sensitive imaging tests, for which Rose Medical Center has developed a special expertise.
Risks for having hyperparathyroidism include head/neck radiation exposure and some inherited family conditions. Low vitamin D levels can also disrupt the calcium/parathyroid balance and must also be checked and corrected. Most patients with hyperparathyroidism do not have any risk factors.
These days, the diagnosis from lab and x-ray tests is often quite reliable. The harder task is to decide when and how to treat hyperparathyroidism because symptoms are not always clear. The timing and type of treatment is often left to the judgment of an endocrinologist who can weigh lab results, symptoms and severity, and other health conditions.
Because there is currently no medical blocker of parathyroid hormone and its effects, surgery is the only cure for hyperparathyroidism. Surgery is performed to find and remove the culprit gland (or glands if more than one is determined to play a part in the disease state). This can be done with a small incision in the lower neck. Surgeons at the Rose Thyroid and Parathyroid Center have a broad experience in surgical techniques, including minimally invasive techniques.
If surgery is refused, or the symptoms are minimal, observation or medical treatment can be done by an experienced endocrinologist. The Rose Thyroid and Parathyroid Center have a number of endocrinologists who are experts in the medical management of hyperparathyroidism. There are medical treatments that can lower blood calcium and protect the stomach, kidneys, and bones from the effects of the elevated PTH and calcium. Some patients can be watched for many years, while for other patients, the effects of the elevated hormones and calcium may worsen to a point that surgery becomes a better choice. Because the body’s calcium balance is complex and delicate, a knowledgeable endocrinologist is needed to weigh the pros and cons of any of these medical or surgical treatments.
Long-term care and monitoring after surgery is also recommended since the disease can re-present later in the remaining parathyroid glands that were not removed.