Parathyroid disorders lead to abnormal levels of calcium in the blood that can cause brittle bones, kidney stones, fatigue and weakness, and other symptoms.
At the University of Michigan, patients with parathyroid disorders are cared for by a multidisciplinary team of experts from endocrinology, endocrine surgery, otolaryngology’s head and neck surgery, nuclear medicine, radiology, and pathology. Our providers are focused on reaching accurate diagnosis through comprehensive testing and providing the best therapy options for each patient.
About Parathyroid Glands
There are normally four parathyroid glands located near or attached to the back surface of the thyroid, each around the size of a grain of rice. Parathyroid glands release a hormone (PTH) in the body that controls the calcium level. Other areas of the body, especially the bones, kidneys and small intestine, respond to this PTH by increasing calcium levels in the blood. Calcium is very important for our bodies, especially for muscle and nerve function.
About Parathyroid Disorders
Normally, if the calcium level in the blood is low, the parathyroid glands sense this and release the hormone PTH. PTH then causes release of calcium from the bones and increases absorption of calcium from the intestines. If the calcium level is too high, then PTH secretion should decrease to a very low level. Parathyroid disorders exist when the glands continue producing PTH even though the calcium level becomes higher than normal (hyperparathyroidism). This can lead to negative effects like osteoporosis, kidney stones, fatigue and mood changes, frequent urination, general aches and pains, and others. The opposite problem, hypoparathyroidism, occurs when the parathyroid glands do not produce enough PTH. This leads to a low blood calcium level and can adversely affect muscle, nerve and other functions.
We treat the following parathyroid disorders:
- Hypoparathyroidism occurs when the body does not produce enough PTH and the calcium level falls below normal.
- Hyperparathyroidism occurs when the body continues producing PTH when the calcium level is higher than normal.
- Primary Hyperparathyroidism is an increase in calcium levels in the blood caused by the growth of benign, or non-cancerous, tumors on one or more of the parathyroid glands. It causes both the calcium and PTH levels to be above normal.
- Secondary Hyperparathyroidism is a change in parathyroid function due to Vitamin D deficiency or renal (kidney) failure.
- Tertiary Hyperparathyroidism is seen in patients who have undergone kidney transplants and have abnormally high parathyroid hormone and calcium levels.
Diagnosis of Parathyroid Disorders
We diagnose parathyroid disorders through comprehensive testing that starts with a complete history and physical exam, and is followed by blood work, which is important for identifying the disorder. We often do an ultrasound of the neck to identify parathyroid glands that may be enlarged. Ultrasounds allow us to guide a needle biopsy, if necessary, to evaluate a nodule or lymph nodes in the neck. Nuclear medicine scans, which use radiopharmaceuticals, also can be used to identify abnormal parathyroid glands causing hyperparathyroidism.
Treatment for Parathyroid Disorders
Hypoparathyroidism is usually treated with a special form of vitamin D (calcitriol) and calcium tablets. It requires careful monitoring to optimize the dosages.
Secondary hyperparathyroidism due to Vitamin D deficiency is easily treated with medication and does not require surgery. Secondary hyperparathyroidism due to renal failure can be controlled with medication in some instances but for those patients with extremely high parathyroid hormone levels, surgery may be needed to adequately control the condition.
Surgery for Primary and Tertiary Hyperparathyroidism
Surgically removing the enlarged or overactive parathyroid can permanently cure the parathyroid disorder. During surgery, the hormone level is measured and should return to normal within 15 minutes of removing the abnormal gland. This means that the result is known before surgery is completed.
Some patients needing parathyroid surgery can be treated with minimally invasive techniques, allowing for an outpatient procedure. The University of Michigan is one of only a few major medical centers in the United States offering a minimally invasive surgical option for the treatment of parathyroid disease. The majority of minimally invasive surgeries can be performed through an incision less than one inch. You may read about the minimally invasive, or “keyhole” surgery.
Minimally invasive techniques offer distinct advantages over conventional surgery including:
- less pain
- reduced scarring
- most patients discharged within hours following surgery
- performed under general anesthesia or local anesthesia with IV sedation
- provides similar cure rates to the conventional approach
Potential candidates for this minimally invasive option include those patients:
- not suffering from primary or secondary hyperthyroidism
- without co-existing medical conditions
- with an identifiable enlarged or hyperfunctioning parathyroid gland
Patients who would be better candidates for traditional parathyroid surgery may have a four gland exploration, performed by identifying each parathyroid gland through the lower neck. In secondary and tertiary hyperparathyroidism, patients may have more than the normal four parathyroid glands. Surgeons will remove some tissue around the thyroid gland to address the extra glands. These patients may remain in the hospital for 3-5 days while they recover and their calcium level is monitored.
After Surgery
Parathyroid operations, regardless of the type, are very well tolerated. Pain is relatively mild. It is not uncommon to have a low calcium level after a successful surgery. That situation is nearly always temporary and normal function is restored in over 98% of people in just a few weeks. Some patients may need to take supplements or receive dialysis to address calcium levels.
Protecting the nerves serving your vocal cords and the remaining parathyroid glands so they will function normally is an important part of your surgery. If the surgery has the potential to affect the voice box, we offer recurrent laryngeal nerve monitoring, to identify and monitor the laryngeal nerve (the nerve to the voice box) to prevent weakness or injury to that nerve during surgery.
Make an Appointment
To see an endocrinologist about your parathyroid disorder, call our clinic at 734-647-5871. Your physician may also refer you to an endocrine surgeon or other specialist at the University of Michigan Health System.