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Parathyroid Disease and Treatment

Parathyroid Disease

The parathyroid glands are four very small oval shaped glands that site behind the thyroid gland and on either side of the trachea. There are typically two superior and two inferior parathyroid glands. There are multiple different disease processes that can affect the parathyroid glands and occur in different settings and present with a range of symptoms. Hyperparathyroidism, one or more overactive parathyroid glands, occurs in 1-3% of the adult population and is more common in females. This disease typically leads to elevated levels of calcium in the blood and symptoms can range from mild to severe. Classically, the symptoms of hyperparathyroidism can include kidney stones, bone pain, abdominal pain, and depression. Long term high calcium levels can lead to diseased vessels of the heart and brain, osteoporosis (weak bones), kidney disease, and many other issues. Sometimes parathyroid disease occurs alone and is not associated with any other issues. In other cases, parathyroid disease is part of larger group of diseases or can occur in the setting of kidney disease. Parathyroid diseases include:

  • Primary Hyperparathyroidism - one or more glands become overactive and function autonomously (produce hormones without the body telling the gland to do so)
  • Secondary Hyperparathyroidism - caused by chronic kidney failure or low levels of Vitamin D
  • Tertiary Hyperparathyroidism - all four glands become overactive and function autonomously in the setting of long term kidney disease (ie kidney transplant)
  • Parathyroid cancer - very rare



Parathyroid Surgery

Sometimes surgery is required in the management of parathyroid disease. The decision to proceed with surgery is dependent on a variety of factors including age, laboratory studies, and overall health status. Surgeries for parathyroid disease include:

  • Minimally invasive radioguided parathyroid surgery (MIRP) for primary hyperparathyroidism
  • Four gland exploration
  • Revision parathyroid surgery



Parathyroid Labs

Prior to surgery for parathyroid disease it is important to have the correct laboratory studies done to confirm the diagnosis. Laboratory studies performed to diagnose parathyroid disease include:

  • Calcium 
  • Intact PTH
  • Ionized calcium 
  • Chloride 
  • Magnesium
  • Phosphorus
  • Vitamin D
  • 24 hour urinary calcium 



Parathyroid Imaging

One or more imaging studies are often needed to diagnose and treat hyperparathyroidism. Imaging to diagnose parathyroid disease includes:

  • Ultrasound
  • 4D-CT
  • Sestamibi
    • 2D
    • SPECT
    • SPECT-CT
  • PET


Safety in Parathyroid Surgery

The risks of parathyroid surgery are similar to those of thyroid surgery and thus similar precautions are taken. These precautions include:

  • Nerve Monitoring (recurrent laryngeal nerve)
  • Intraoperative Parathyroid hormone (PTH) Monitoring


To learn more about the diagnosis and treatment of parathyroid disease we recommend the following references.