What are Parathyroid Glands?

Parathyroid glands are small glands that are situated behind the thyroid. We have 4 parathyroid glands, two on the right and two on the left. Normal parathyroid glands are about the size of a grain of rice, but when a parathyroid gland develops into a tumor, it can grow to be about the size of an almond or a walnut.

The purpose of the parathyroid glands is to control the amount of calcium in our blood, bones and nerves. Parathyroid glands have a very important job to do--thus it is the only quadruple-redundant system we have. Because calcium is used to help run the electrical system of our nerves, and to keep our bones hard, our bodies control calcium in a very narrow normal range. The four parathyroid glands secrete parathyroid hormone (PTH) at all times to regulate how much calcium is in our nerves, our blood, and our bones.

What is Hyperparathyroidism?

Hyperparathyroidism is a disease caused by a tumor of one of the four parathyroid glands in the neck. The parathyroid tumor is almost always benign, but it over-secretes too much parathyroid hormone which causes hypercalcemia--or too much calcium in the blood.

The symptoms of hyperparathyroidism can be mild or severe, but most people have symptoms, the most common of which are: feeling tired all the time, generalized body aches, bone aches, high blood pressure, and chronic fatigue. Because the excess parathyroid hormone secreted by the parathyroid tumor takes calcium out of the bones and puts it into the blood, virtually all patients with a parathyroid tumor will get bad osteoporosis. The excess calcium in the blood will cause kidney stones in many patients.

About 75% of cases of hyperparathyroidism are caused by a tumor on one of the four parathyroid glands. In 25%, however, more than one parathyroid gland is involved and if these patients have only one parathyroid tumor removed, they will not be cured and will need a second parathyroid operation to find the second tumor.

How is Hyperparathyroidism Diagnosed?

The hallmark of hyperparathyroidism is hypercalcemia: too much calcium in the blood. The diagnosis of hyperparathyroidism therefore involves showing too much calcium in the blood--which is a routine blood test for this reason. If an adult over 35 has blood calcium levels over 10.1 mg/dl (2.5 mmol/l in Canada and Europe), then they are very likely to have a parathyroid gland tumor and hyperparathyroidism. The workup of hyperparathyroidism dictates that your doctor will check blood calcium levels and the amount of parathyroid hormone (PTH) that the parathyroid glands are secreting. You may also be checked for vitamin D deficiency (which occurs in most patients with a parathyroid tumor) as well as a bone density test checking for osteoporosis.

Who Gets Hyperparathyroidism?

Hyperparathyroidism increases in frequency with age. Women comprise 75% of all patients with hyperparathyroidism (and nobody knows why). Thus, the "typical" patient with hyperparathyroidism is a 60 year old woman. But, men get it too! Approximately 1% of women will get hyperparathyroidism during their lifetime, while about 0.5% of men will. Children almost never get hyperparathyroidism. Teenagers can get it, but it is quite rare. The vast majority of patients are over the age of 25.

How Do You Treat Hyperparathyroidism?

Hyperparathyroidism is treated with surgery--this is the only known treatment and it is appropriate for patients of all ages. Surgery will cure the disease when the parathyroid gland tumor that is over-secreting parathyroid hormone is removed. Since we have 4 parathyroid glands, removing one or two of them poses no problems at all--we only need about one-half of one.

Parathyroid surgery is very challenging because the patient can have one, two, three or even all four parathyroid glands involved. The tumor can be on the right or the left, the upper or the lower parathyroid gland. For this reason, the medical literature is full of many scientific articles showing that surgeon experience matters--surgeons who perform the most parathyroid operations are expected to have the highest cure rates and lowest complication rates.

Minimally invasive parathyroid surgery is practiced almost exclusively at our hospital, giving patients the best cosmetic outcomes, and some of the highest cure rates.

Our Parathyroid Surgeons

We are very fortunate to have some of the most experienced parathyroid surgeons in the world who collectively have performed more than 50,000 parathyroid operations. One of the surgeons on our staff is the inventor of radioguided parathyroid surgery and is known world-wide for his advances in parathyroid surgery. Nearly all of our parathyroid surgeons perform parathyroid surgery exclusively. We now perform over 3,500 parathyroid operations annually, on patients from all 50 states and dozens of foreign countries. The parathyroid surgeons on our staff have published over 500 scientific articles, and are frequent speakers at national and international meetings on the techniques of parathyroid surgery.