Parathyroid Disorders Treated in the Department
Hypercalcemia means elevated blood level of calcium. Most of the time this is very mild condition and does not cause any symptoms. Most of the patients are discovered accidentally. If calcium in blood increase more than 1 mg/dl over normal level some symptoms may appear. Most common is thirst and frequent urination. Another include high blood pressure some heartburn, and some mild mental disturbances. In otherwise healthy people most common reason is primary hyperparathyroidism (see below). Rarely may be caused by overactive thyroid, underactive adrenal gland or due to intoxication with vitamin D or vitamin A. In otherwise sick individuals causes also include cancer and diseases where granulomas are formed in the body. Treatment depends on cause.
Hypocalcemia means decreased blood level of calcium. Symptoms of hypocalcemia are those of overactive nerves and muscles and include tingling, numbness of body parts (especially around the mouth and I fingertips) as well as muscle twitching. Severe hypocalcemia may lead into the whole body spasm (tetany). This condition is most commonly caused by the lack of parathyroid glands (after surgery or radiation) or severe Vitamin D deficiency. Treatment consists of supplementation with calcium and vitamin D.
This is a condition in which parathyroid glands produce too much of parathyroid hormone. This is usually caused by small tumor in one of the glands. Patients present with hypercalcemia (elevated blood calcium). Best treatment is surgery to remove abnormal tissue. However some patient can be monitored if calcium is just slightly elevated.
This is a condition in which parathyroid hormone is elevated but this is not caused by abnormal secretion from parathyroid glands. Rather it is caused by either low calcium level (in the cases of vitamin D deficiency) or elevated blood phosphorus level (in patients who have severe kidney insufficiency). If low calcium, or high phosphorus are corrected, secretion of parathyroid hormone returns to normal.
Tertiary hyperparathyroidism is condition in which long standing secondary hyperparathyroidism cannot be reversed any more even by adequate treatment. Most commonly we see this in patients with kidney failure and these patients are best treated by surgical removal of parathyroid glands.
Is a condition in which secretion of PTH is diminished. This is most commonly caused by removal of parathyroid glands during the neck surgeries, or after radiation treatment in this area. This causes hypocalcemia (low blood levels of calcium). These patients are treated with vitamin D and calcium.
Is a very rare genetic condition in which body cannot sense parathyroid hormone. These patients have symptoms of hypoparathyroidism but have normal blood levels of parathyroid hormone. Treatment is with calcium and vitamin D.
Is a very rare disease and is characterized with mass in the neck. These tumors often produce parathyroid hormone. Symptoms are caused by local effects of the tumor, possible metastases and to hypercalcemia. Treatment consists of surgical removal of tumor whenever possible.
Instructions for your appointment
When coming to your first appointment:
If you have been referred for any of parathyroid conditions from above list make sure you bring to your appointment all your medication bottles, any available records, reports or films relevant to the thyroid. Try to collect and write down family medical history prior to the visit. There is no need for fasting before visit.
Special procedures & treatments
Neck ultrasound can be used to try to identify abnormal parathyroid gland. This is best left to be done by the surgeon before operation. Negative ultrasound does not exclude possibility of small tumor.
Sestamibi scan is nuclear medicine procedure for localization of abnormal parathyroid tissue. This involves administration of radioactive contrast and several imaging sessions after that. This method cannot uncover all cases and should be used judiciously.
Fine needle aspiration
Fine needle aspiration is a method of obtaining a tissue sample from suspected parathyroid tumor. This is rarely necessary.