Parathyroid disease and parathyroid surgery (parathyroidectomy) to treat hyperparathyroidism is a treatment offered by Dr. Greg Rohn and Dr. Brad Gamble of Otolaryngology Specialists of North Texas (OSNT).
Parathyroid Anatomy and Physiology
The four parathyroid glands regulate calcium in the blood by releasing parathyroid hormones (PTH) when the body’s calcium levels are low and ceasing production of PTH when the body has sufficient calcium. These tiny parathyroid gland are located behind the thyroid with two on either side of the neck. When one or more of the parathyroid glands releases too much PTH, a calcium imbalance results, which can affect many of the body’s functions.
Hyperparathyroidism is a medical condition in which the parathyroid glands overproduce the parathyroid hormone (parathormone).
Types of hyperparathyroidism include:
- Primary hyperparathyroidism: Hormone overproduction occurs due to the enlargement of at least one of the parathyroid glands.
- Secondary hyperparathyroidism: Occurs when disease causes the parathyroid gland to overproduce PTH.
Patients with hyperparathyroidism may present symptoms or be asymptomatic, depending on the blood calcium levels. When calcium levels become too high, a patient can develop hypercalcemia, which can cause kidney stones, weaken bones, and interfere with brain and heart function. Symptoms of hypercalcemia may include:
- Muscle aches or weakness
- Nausea or vomiting
- Loss of appetite
- Excessive thirst
- Frequent urination
- Bone fractures
- Kidney stones
Left untreated, hypercalcemia can lead to:
- Kidney failure
- Enlarged heart
- Arrhythmia/coronary heart disease
Primary hyperparathyroidism is usually the result of tumors called adenomas in the parathyroid gland. While adenomas are typically benign, they can be cancerous. Parathyroid adenomas produce the parathyroid hormone without shutting down when blood calcium levels are sufficient. In approximately 80% of hyperparathyroidism cases, adenomas affect only one of the parathyroid glands.
Primary hyperparathyroidism can also be caused by hyperplasia, the enlargement of the parathyroid glands.
Secondary hyperparathyroidism occurs when another condition present in the body lowers calcium levels. As a result, the parathyroid glands overproduce in order to compensate for the loss of calcium. Contributing factors to secondary hyperparathyroidism can be:
- Chronic kidney failure: Kidneys which function poorly are unable to convert vitamin D into a usable form.
- Severe vitamin D deficiency: Calcium levels can drop when the body lacks vitamin D, which aids in absorption of calcium.
- Severe calcium deficiency: Usually occurs when the digestive system is unable to absorb calcium properly.
Diagnosing and Treating Hyperparathyroidism
Hyperparathyroidism is typically diagnosed through blood or urine testing. Your doctor will check for elevated PTH and calcium levels. If lab work shows hyperparathyroidism, your doctor may recommend additional tests to identify the cause and determine the severity:
- Bone densitometry (bone mineral density test): Measures grams of calcium in bone segments.
- X-rays: To check for kidney stones or other abnormalities.
- 24 hour urine collection: To calculate kidney function and calcium levels in urine.
Mild cases of hyperparathyroidism, where kidney function and bone density are normal and calcium levels are only slightly elevated, are generally monitored periodically with no treatment recommended. For symptomatic or more severe cases of hyperparathyroidism, removing the affected glands surgically is the only cure.
Parathyroidectomy (Parathyroid Surgery)
Parathyroidectomy involves removal of diseased parathyroid glands. The remaining healthy parathyroid glands will continue to control calcium levels. Benefits of parathyroid surgery include:
- Improved bone health: Statistics show significant increase in bone density continuing for up to 10 years post-parathyroidectomy.
- Reduced risk for kidney stones: Studies show dramatic decrease in kidney stone episodes within the first year after a parathyroidectomy, with further decline for several years, thus avoiding procedures like lithotrypsy to pulverize kidney stones.
- Improved quality of life: 70% of patients report improved well-being as related to health issues.
Types of Parathyroid Surgery
When all four parathyroid glands need to be explored visually, a bilateral neck exploration is performed. An incision is made in the middle to lower front of the neck and diseased parathyroid glands are identified and removed. In most cases, only one parathyroid gland is affected and a minimally invasive parathyroidectomy (MIP) can be performed, such as:
- Radio-guided parathyroidectomy: Least invasive method in which the diseased gland absorbs a small and safe amount of a radioactive material. A special probe is used, which locates the hyperactive parathyroid tumor. General anesthesia is typically not needed, and the patient can usually return home within a couple of hours.
- Video-assisted parathyroidectomy (VAP): A tiny video camera is inserted into a small incision, while the procedure is performed through another. Locoregional anesthetic is used, rather than general, allowing for a relatively fast recovery time.
- Endoscopic parathyroidectomy: Similar to VAP, 2 or 3 small incisions are made and the affected parathyroid gland is removed. Scarring is minimal and success rate is high.
Benefits of minimally invasive parathyroidectomy include:
- High success rate
- Little scarring and discomfort
- Shorter recovery time
- No general anesthesia required
In cases such as parathyroid hyperplasia, where all four parathyroid glands are affected, surgery typically involves removal of 3 glands and a portion of the fourth, leaving some functioning tissue intact, or re-implanted in the neck muscles or forearm, to control calcium levels.
Recovering From Parathyroid Surgery
Recovery time after a parathyroidectomy will depend on the type of surgery you have. You may have a sore throat or cold symptoms for a few days. Your doctor will monitor your calcium levels, as they general drop after a parathyroidectomy. Most patients will need calcium supplementation for at least a short time, until the remaining parathyroid glands adjust.
Parathyroidectomy is successful in approximately 95% of cases, and is considered an extremely safe procedure with low risk of complications.
If you are experiencing symptoms of hyperparathyroidism, or are concerned that your calcium levels are out of balance, please contact the Otolaryngology Specialists of North Texas (OSNT) for an appointment.