The four tiny parathyroid glands are situated in your neck, behind the thyroid gland. They make parathyroid hormone, which helps to keep a steady level of calcium in your body. Calcium is important, not only for your bones and teeth but also for muscles and nerves. Hyperparathyroidism means you have too much (hyper) parathyroid hormone in your bloodstream. This is probably because one or more of the parathyroid glands is too active.
There are two kinds of hyperparathyroidism. Primary hyperparathyroidism happens because one of the parathyroid glands gets bigger and produces more hormone. This extra amount of hormone means there is extra calcium in the bloodstream. This can cause a number of problems, including confusion and kidney stones. Primary hyperparathyroidism is usually treated by surgery to remove the enlarged gland.
The other kind of hyperparathyroidism is called secondary. It happens because some other problem reduces the level of calcium in the body, so the parathyroid glands step up production of the hormone to put more calcium in the bloodstream. They get this calcium from the bones, weakening them.
Hyperparathyroidism is a “silent” disease because it is often diagnosed before symptoms appear.
The word is a mouthful — hyperparathyroidism — but it stands for a series of symptoms that can make life uncomfortable. It can be frightening as well, especially when the body seems to be changing on its own and where the person experiencing the transformations might be wondering if they will ever have their body and mind back.
Symptoms are fairly general but uncomfortable. They include nausea, constipation, abdominal pain, and even kidney stones. Excess calcium in the bloodstream can also cause mental confusion, leading to a diagnosis of dementia, although this is entirely treatable. Surgery is one course of treatment, but medication therapy and monitoring start out the process. Treatment aims to stop calcium being released from the bones, preventing osteoporosis and relieving the uncomfortable symptoms that arise from too much blood calcium. Kidney stones are a possible side effect because the release of calcium from the bones leads to an increase of phosphate which is got rid of by the kidneys. (Bones are made of calcium phosphate.)
Calcium is a mineral (think “chalk”) that affects body functions such as bone formation, the release of hormones and even muscle, brain, and nervous system functioning. The parathyroid hormone influences calcium absorption, release from the body, and its release into the system from the bones.
The Types Of Hyperparathyroidism
One of two types of hyperparathyroidism could be the culprit for putting too much calcium into the blood stream. In the primary variety, the parathyroid glands enlarge to overproduce parathyroid hormone to cause hypercalcemia (too much calcium). Surgeons can go in and remove one or more of the four glands to force regulation of the hormone after checking whether one or more of these glands is over active.
In secondary hyperparathyroidism, the gland appears to under-produce calcium and then increase its production too much. This is secondary to an underlying disease that does not originate in the parathyroid gland.
Medication therapy inhibits the loss of calcium from the bones, and may include the use of Vitamin D which is good for bone health. Other medications may work to thwart high calcium levels.
Management And Monitoring
Once the elevated calcium levels are noted, medication is usually prescribed, along with a strong suggestion to increase physical activity, and monitoring of disease progression. Bone density tests, creatinine, and calcium levels will be monitored.
Surgery for Hyperparathyroidism
Surgery is the best option for high calcium levels that continue despite lifestyle changes. Surgery is also indicated if kidney stones are present, or where bone fractures and osteoporosis occur.
In this case, it is key to find a surgeon who is adept at reaching the tiny glands in the neck without harming the vocal chords, the airway, or any main arteries or veins. So if the problem is only a small one, your doctor may advise waiting to see whether medication is sufficient to keep the matter in check.
There are two forms of surgery. The traditional one requires a large incision. It takes longer to heal from this, and can cause hoarseness of the voice. The other is called mini parathyroid surgery. This is minimally invasive but requires a surgeon with a great deal of specialized experience. Its plus side is that it saves the patient from potential harm by targeting the parathyroid location, without cutting open the entire neck and recovery is much quicker.