Parathyroid glands are pea-sized glands located near each corner of the back side of the thyroid gland in the neck. Most people have four parathyroid glands, but some people may be missing a gland or have an extra gland. Parathyroid glands produce a substance called parathyroid hormone (PTH), which controls the levels of calcium in the blood and in the bones. Having the proper level of calcium in the body allows the nervous and muscular systems to function properly. They also help the body make vitamin D and helps prevent loss of too much calcium in the urine.

What diseases of the parathyroid glands does a surgeon treat?

The primary disease of parathyroid glands is overactivity, which is when too much parathyroid hormone is produced. This is called primary hyperparathyroidism. Under this condition, one or more of the parathyroid glands behaves inappropriately by making excess hormone regardless of the level of calcium that is already present within the body.

The most common cause of excess hormone production is the development of a benign tumor in one of the parathyroid glands. This enlargement of one parathyroid gland is called a parathyroid adenoma which accounts for the majority of all patients with primary hyperparathyroidism.

Like any other part of the body, malignancy (or cancer) can also occur in the parathyroid glands. Cancer of the parathyroid is a clear indication for surgical treatment.

Lastly, secondary hyperparathyroidism, or secondary HPT - is a parathyroid disease that is common in patients with chronic kidney disease who are on dialysis. In secondary HPT, the parathyroid glands make too much parathyroid hormone (PTH) because the kidneys have failed, and the calcium and phosphorus are out of balance.

What are the symptoms of these diseases?

Primary hyperparathyroidism requires treatment because it leads to symptoms such as hypercalcemia, kidney stones, osteoporosis, and a variable amount of other symptoms that often make people feel poorly. By far, the most common symptom is fatigue, but depression, memory loss, and bone aches are also very common. Other symptoms of primary hyperparathyroidism are the development of gastric ulcers and pancreatitis.

Sometimes the symptoms of parathyroid disease are really obvious, like kidney stones, frequent headaches, and depression. Sometimes the symptoms are not so obvious, like high blood pressure and the inability to concentrate.

In secondary hyperparathyroidism and parathyroid cancer, the patient may not have any symptoms. However, treating these diseases is still important, as they can have a major impact on the patient's health.

How are these diseases diagnosed?

If a patient has elevated calcium, several different types of tests can be used to locate the abnormal glands. The most common and most accurate test to find a parathyroid tumor is the Sestamibi scan. This test is usually ordered by an endocrinologist or a surgeon that specializes in parathyroid surgery.

The Sestamibi scan is an imaging study that is performed in the nuclear medicine department of the hospital or imaging center. The patient is given an intravenous injection of Tc99m MIBI, a radioisotope that will help to identify the parathyroid adenoma. The patient is then imaged with a special camera called a gamma camera which will show the parathyroid glands. This test can identify the majority of parathyroid adenomas.

How are these diseases treated?

Surgery is the most common and the most effective way to treat the diseases of the parathyroid gland. Parathyroid tumors must be removed by a surgeon. If you have primary hyperparathyroidism you will need to have parathyroid surgery.

Even if a patient has a non-localizing Sestamibi scan (a negative Sestamibi scan), he/she should almost always have a neck exploration to look for and remove the tumor if he/she has high calcium levels, among other the other symptoms of parathyroid disease.

Parathyroidectomy is the surgery of choice for treating primary hyperparathyroidism, parathyroid adenomas, and malignancies. Sometimes, the surgeon will choose to perform a neck exploration at the time of the parathyroidectomy. Parathyroidectomy is performed under general anesthesia, usually by a general surgeon. After surgery, some patients will need to take calcium supplements for a time to help their calcium levels stay within a normal range.