Most-Common Parathyroid Condition: Too Much Hormone
The parathyroid glands are four small glands about the size of a baby pea. They are usually found on the backside of the thyroid gland. Specialists may have to use some effort to locate them in this area of the neck, as they are not in the same position in all patients.
The parathyroids respond to—and, in effect, monitor and control—the level of calcium in the blood. The hormone they secrete causes bone to release calcium (and regulates excretion of calcium in the urine and absorption of calcium from the intestines). These processes are important in the body's ability to raise and thus adjust the level of this mineral in the blood, which is important at all times to proper function of muscles and nervous tissue.
Too much parathyroid hormone (hyperparathyroidism) can causes bones to release too much calcium. The result is blood-calcium levels that are too high. This usually happens when one of the parathyroid glands goes bad, typically as a result of benign enlargement. In primary hyperparathyroidism, one or more of the parathyroid glands swells (due to adenoma or hyperplasia) and releases too much parathyroid hormone. Older white women are greater risk for the condition.
Most cases of primary hyperparathyroidism are mild. Treatment may mean conservative steps, medical intervention or surgery. But the prognosis for controlling or resolving the condition is good.
Symptoms of hyperparathyroidism may be very noticeable or so slight that they are difficult to discern. When evident, they can include a variety of nonspecific signs such as:
- muscle cramps;
- memory loss;
- confusion, foggy thinking;
- painful bones;
- calcium-caused irritation or inflammation of the stomach or pancreas;
- and calcium-based kidney stones.
In addition, when bones release calcium at a higher rate than they replace it, a thinning of the bone matrix called osteoporosis results.
A blood test of calcium levels and parathyroid hormone levels is the primary step used to reveal the condition. In this test, a simultaneous elevation of calcium (hypercalcemia) and parathyroid hormone indicates hyperparathyroidism.
Often, doctors detect the condition because calcium levels are typically included in metabolic panels run as part of blood testing for physicals or diagnostic blood testing. Calcium levels are very important and should never be high. Noting high calcium levels, the physician will then follow with a parathyroid-hormone test. Not uncommonly, this will allow the clinician to detect the condition early, before its symptoms are evident.
Patients with mild hyperparathyroidism and minimal or no symptoms may not need treatment. Patients who need treatment can chose to either try to manage the symptoms or have the abnormal gland removed through surgery. Most patients will be evaluated for surgery, which is the only direct treatment approved for the condition—and an intervention that succeeds in 95 percent of cases.
If left untreated, the condition can become more severe. In addition, osteoporosis drugs are not effective in the presence of an abnormal parathyroid. For these reasons, and because operations for parathyroid operations have become increasingly easier for the patient to undergo, and more accurate in their targeting, most patients will choose to have surgery.
Hyperparathyroidism can also be secondary to kidney failure, which causes the parathyroids to be overactive, or to parathyroid cancer. A new class of drugs called calcimimetics used for these conditions can stop the parathyroids from secreting. Though these drugs have not been FDA approved for primary parathyroidism, some doctors will prescribe them for this purpose.
Patients with primary hyperparathyroidism may need regular check-ups to monitor calcium levels and symptoms. Lourdes endocrinologists are experienced at managing this condition.