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PARATHYROID GLAND

Parathyroid glands are tiny structures located on the posterior aspect of the thyroid glands. Normally there are four parathyroid glands and each weighs approximately 60 mg. Parathyroid gland control your blood calcium levels.

About Parathyroid Gland

Parathyroid glands are tiny structures located on the posterior aspect of the thyroid glands. Normally there are four parathyroid glands and each weighs approximately 60 mg. Parathyroid gland control your blood calcium levels.

Excess hormone results in high levels of serum calcium and low levels result in hypocalcemia. High levels can be due to

Primary hyperparathyroidism: This can be due to adenoma or carcinoma
Secondary hyperparathyroidsm : This is usually due to renal failure
Tertiary hyperparathyroidism

Enlargement of parathyroid can be due to parathyroid hyperplasia or parathyroid gland tumor. This results in increased parathyroid hormone levels in the body which can affect other systems like bone, kidney, heart, blood pressure, pancreas etc.

Thyroid Disorders

Hyperparathyroidism:

When too much parathyroid hormone is produced it is called hyperparathyroidism. Here, one or more of the parathyroid glands behaves inappropriately by making excess hormone regardless of the level of calcium. In other words, the parathyroid glands continue to make large amounts of parathyroid hormone, even when the calcium level is normal and they should not be making hormone at all. Over-production of parathyroid hormone by overactive parathyroid glands (hyperparathyroidism) can make you feel run down and tired, causing osteoporosis, renal stones, and psychiatric disturbances

The most common cause of excess hormone production is the development of a benign (non-cancerous) tumor in one of the parathyroid glands. This enlargement of one parathyroid gland is called a parathyroid adenoma, and it accounts for 96% of all patients with primary hyperparathyroidism. Approximately 3% or 4% of all patients with primary hyperparathyroidism will have an enlargement of all 4 parathyroid glands, a term called parathyroid hyperplasia. In this instance, all of the parathyroid glands become enlarged and produce too much parathyroid hormone. This is a much less common scenario, but the end results on the tissues of the body are identical.An even rarer situation occurs in less than 1% of the people who have 2 parathyroid adenomas while having 2 normal glands. This is very uncommon and can make the diagnosis and treatment of this disease a bit tricky

Symptoms of Hyperparathyroidism

Symptoms of hyperparathyroidism were first described in 1925, the symptom complex has become known as “moans, groans, stones, and bones. ” Although most people with primary hyperparathyroidism claim to feel well when the diagnosis is made, the majority will actually say they feel better after the problem has been cured. Many patients who thought they were asymptomatic pre-operatively will claim to sleep better at night, be less irritable, and find that they remember things much easier than they could when their calcium levels were high. In some studies, as many as 92% of patients claimed to feel better after removal of a diseased parathyroid gland, even when only 75% claim they felt “bad” before the operation. Patients with persistently elevated calcium levels due to overproduction of parathyroid hormone also can have complaints of bone pain. In the severe form, bones can give up so much of their calcium that the bones become brittle and break. Bones can also have small hemorrhages within their center that will cause bone pain. Other symptoms of hyperparathyroidism are the development of renal stones, gastric ulcers,and pancreatitis. High levels of calcium in the blood can be dangerous to a number of cells, including the lining of the stomach and the pancreas, causing both of these organs to become inflamed and painful (ulcers and acute pancreatitis)

Diagnosing Hyperparathyroidism

Usually, a normal calcium level will be associated with a normal parathyroid hormone level. Also under normal conditions, a low serum calcium level will be associated with a high parathyroid hormone level; a high calcium level will be associated with a low parathyroid hormone level. These are all appropriate ways in which a parathyroid gland will react to calcium that is circulating in the blood as they attempt to regulate calcium in the narrow normal range. Hyperparathyroidism is relatively easy to detect because the parathyroid glands will be making an inappropriately large amount of parathyroid hormone in spite of elevated serum calcium. This is straightforward and simple to measure. Another way to confirm a hyperparathyroidism diagnosis is by measuring the amount of calcium in the urine over a 24-hour period. If the kidneys are functioning normally, they will filter much of this calcium in an attempt to rid the body of calcium, leading to an abnormally large amount of calcium in the urine

Parathyroidectomy

The common parathyroid surgeries offered are:

1) Bilateral four gland neck exploration:
Commonly performed in
  • Familial hyperparathyroidism
  • Multiple endocrine Neoplasia
  • Non localized primary hyperparathyroidism
  • Secondary hyperparathyroidism
2) Unilateral single gland parathyroidectomy:
This can be done by focussed approach (2cm small incision) or unilateral exploration of one side of neck Performed for unilateral single gland disease
3) Total Parathyroidectomy with autotransplantation to forearm n MEN 1

Suggested Readings in Parathyroid

  • Pradeep PV, Ramalingam K. Familial isolated hyperparathyroidism: Role of Intraoperative PTH assay. Indian J Surgery 2011. Manuscript ID: IJOS-D-10-00418. (Online 1st 12/03/12; http://www.springerlink.com)
  • Pradeep PV, Vydehi B. Local recurrence as a first sign of parathyroid malignancy! Need to redefine the criteria for diagnosis of parathyroid carcinoma. Indian J Endocrinol & Metab 2012. (Manuscript ID: IJEM 85-12 In Press)
  • Pradeep PV, Jayashree B, Mishra A, Mishra SK. Systematic review of primary hyperparathyroidism in India: the past, present and future trends. Int J Endocrinology 2011;2011:921814: Epub 2011 May 26 doi:10.1155/2011/921814
  • Pradeep PV, Mishra A, Agarwal G, Agarwal A, Verma AK, Mishra SK. Long-term outcome after parathyroidectomy in patients with advanced primary hyperparathyroidism and associated vitamin D deficiency. World J Surg. 2008 May;32(5):829-35.
  • PV Pradeep, SK Mishra. Current concepts in the management of Primary Hyperparathyroidism. Annals of Endocrine Surgery 2006, 9(1): 14-17

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  • Dr PV Pradeep
    Department of Endocrine Surgery
    Baby Memorial Hospital
    Kozhikode, Kerala - 682134
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