The parathyroid glands are four pea-sized endocrine glands located on the back side of the thyroid in the neck. Though their names are similar, the thyroid and parathyroid glands are entirely different glands, each producing distinct hormones with specific functions. Parathyroid glands secrete a hormone called parathyroid hormone (PTH) which regulates the amount of calcium and phosphorus that circulates through the blood. Occasionally, one or more of these glands becomes enlarged and produces excessive amounts of parathyroid hormone. The extra parathyroid hormone causes bones to dissolve and raises the blood calcium level. This disease is called primary hyperparathyroidism.
How Common is Hyperparathyroidism?
In the United States, about 100,000 people develop a parathyroid disorder each year. Women hyperthyroid patients outnumber men by a ratio of 2-to-1, and risk increases with age. In women age 60 or older, 2 out of 1,000 will develop hyperparathyroidism each year.
Diagnosis of Hyperparathyroidism
Hyperparathyroidism is diagnosed when a blood test reveals blood calcium levels and blood parathyroid hormone levels are too high. Other diseases can cause high blood calcium levels, but only in hyperparathyroidism is the elevated calcium the result of too much parathyroid hormone.
Hyperparathyroidism can lead to:
- Severe osteoporosis (bone loss), which can result in bone fractures, spinal cord compression and severe pain
- Kidney stones, which can cause severe abdominal pain and kidney infections; abdominal pain from stomach ulcers and pancreatitis
- Muscle aches and pains
- Excessive urination at night
- Nerve damage
In most cases, hyperparathyroidism is caused by a benign (non-cancerous) tumor in a single parathyroid gland that produces excessive hormone. But occasionally, multiple glands are overactive and must be removed. Parathyroid surgery (parathyroidectomy) is the primary treatment to remove one or more of the four parathyroid glands. Surgery can usually be performed in a minimally invasive fashion by an experienced (more than 100 neck surgeries a year) endocrine surgeon who knows preoperatively where the abnormal glands are located in the neck.
Patients with normal calcium levels should speak with their primary care physicians about alternative treatments to surgery. Patients with kidney failure and high calcium levels are often disqualified for surgery and should discuss medical treatment options with their nephrologists.
Identifying Abnormal Parathyroid Glands
Accurate preoperative localization of abnormal parathyroid glands is imperative for successful minimally invasive parathyroid surgery. Recent advances in technology have allowed for preoperative localization of abnormal parathyroid glands with outpatient nuclear parathyroid scanning (Sestamibi scanning) and diagnostic high-resolution neck ultrasounds.
Endocrinologists with head and neck ultrasound training are among the most skilled at locating these glands with these high-tech procedures. Otherwise a full neck exploration is required to examine all of the parathyroid glands to determine which glands are abnormal. Full neck exploration requires a 2- to 3-inch incision, can be complicated by injury to structures on both sides of the neck, and most often requires a two- to three-day hospital stay.
R. Mack Harrell, MD, of the Memorial Center for Integrative Endocrine Surgery, has specialized training in diagnostic high-resolution neck ultrasound and has performed more than 5,000 of these procedures since 1991. He is among fewer than 200 physicians in the United States who have completed the Endocrine Neck Ultrasound (ECNU) program administered by the American Association of Clinical Endocrinology (AACE). The center is accredited by the American Institute of Ultrasound in Medicine (AIUM), which develops national standards and guidelines for ultrasound practices.
Minimally Invasive Radio-Guided Parathyroid (MIRP) Surgery
Successful surgical treatment of hyperparathyroidism not only requires sophisticated technology and specialized skills, but also teamwork between the endocrinologist and endocrine surgeon. Dr. Harrell and David Bimston, MD, of the Memorial Center for Integrative Endocrine Surgery, have pioneered a coordinated and multidisciplinary approach for the evaluation and removal of parathyroid tumors, using minimally invasive techniques.
Minimally invasive radio-guided parathyroid surgery has a 95 percent success rate and is associated with a low risk of injury to other neck structures. The surgical procedure is performed through a 1-inch incision that heals quickly during recovery. The operation rarely takes longer than an hour or requires an overnight stay. Through the use of intra-operative parathyroid hormone testing, Dr. Bimston can confirm the results of the operation before the patient leaves the operating room.
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