Introduction
- The parathyroid glands are oval shaped and 4 in number. They are the size of a grain of rice and placed behind the thyroid gland in the neck
- The parathyroid glands produce parathyroid hormone or parathormone (PTH) which controls the circulation and use of calcium in the body.
- Calcium is essential for normal functioning of
- Our brain and nervous system
- All our body muscles including smooth muscles like the heart
- Our bones. Calcium deposit makes the bones strong. The bones also act as storage houses for calcium
Signs and symptoms
- These arise due to bad functioning of one or more of the parathyroid glands resulting in uncontrolled excessive secretion of parathyroid hormone. In most cases it is a single parathyroid gland which is affected. Infrequently two glands may be involved. The affected gland may be enlarged to the size of a pea or more and is called a parathyroid adenoma. This gland continues to secrete PTH and causes circulating calcium levels to increase. All signs and symptoms of the disease are due to high levels of calcium in the blood
- The nervous system slows down, the patient feels tired and depressed
- Colicky pain in the abdomen
- Palpitations
- Kidney stones
- Weak bones due to calcium loss causing pain and even fractures with minor trauma
Diagnosis
- High circulating serum calcium levels along with raised blood levels of PTH are diagnostic of hyperparathyroidism
- Sestamibi scan helps localise the affected gland
- An ultrasound of the neck and CT scan help determine the size and position of the gland. This helps in targeted mini parathyroid surgery
Complications
- If left untreated hyperparathyroidism is a progressive disease and can result in severe insult to the patient and even death
- Osteoporosis leading to fractures and destruction of the skeletal system
- Heart disease especially problems of heart rhythm. High blood calcium causes the heart to beat much faster, a condition known as atrial fibrillation
- Depression
- Kidney stones
Treatment
- Almost all patients of hyperparathyroidism will require surgical removal of the affected gland.
- Endoscopic removal is performed for cosmetic benefits
- In high risk patients with long standing disease a targeted direct mini approach is better and safer once the gland is localised. This approach is much quicker and decreases anaesthesia time.
Post operative recovery The level of calcium circulating in the blood is likely to fall after removal of the diseased gland. Calcium levels need monitoring for a few days and replacement of calcium may require intravenous calcium injections. The patient may be on a normal diet and moving around but will need to stay in hospital till calcium levels stabilise.