Understanding the parathyroid: Function, disorders, and treatment

The parathyroid glands are small but vital organs in the neck. Despite their importance, they are often overlooked until something goes wrong.

In this guide, consultant ENT surgeon Mr Brian Fish explores what the parathyroid glands do, common disorders affecting them, symptoms to watch for, and the treatment options available.

What are the parathyroid glands?

The parathyroid glands are four tiny glands, each about the size of a grain of rice, located behind the thyroid in your neck. Their main job is to produce parathyroid hormone (PTH), which helps control calcium and phosphate levels in your blood. Calcium is essential not only for strong bones and teeth but also for proper nerve and muscle function, making the parathyroid glands crucial for overall health.

How the parathyroid works

Parathyroid hormone regulates calcium by:

• Increasing calcium absorption from the gut via vitamin D activation.
• Releasing calcium from bones when levels are low.
• Reducing calcium loss in urine by acting on the kidneys.

This delicate balance ensures that your body has just the right amount of calcium at all times.

Common parathyroid disorders

Parathyroid disorders usually occur when the glands produce too much or too little PTH.

Hyperparathyroidism

This is when one or more glands produce too much hormone. It can lead to:

• Weak or brittle bones (osteoporosis).
• Kidney stones.
• Fatigue or weakness.
• Mood changes.

Hyperparathyroidism often develops slowly, and many people may not notice symptoms until complications arise.

Hypoparathyroidism

Less common than hyperparathyroidism, this occurs when the glands produce too little hormone. Low calcium levels can cause:

• Muscle cramps or spasms.
• Tingling in the fingers, toes, or around the mouth.
• Fatigue or confusion.

Hypoparathyroidism is often caused by surgical injury during thyroid or neck surgery, but it can also be genetic or autoimmune.

Diagnosis and tests

If a parathyroid disorder is suspected, your doctor may recommend:

• Blood tests to measure calcium, phosphate, and PTH levels.
• Urine tests to check calcium excretion.
• Imaging such as ultrasound or nuclear scans to locate abnormal glands.

Early diagnosis is important to prevent long-term complications such as kidney damage or severe bone loss.

Treatment options

Treatment depends on the type and severity of the disorder.

Managing hyperparathyroidism

• Surgery to remove the overactive gland is often the definitive solution.
• Monitoring and medication may be appropriate for mild cases.

Treating hypoparathyroidism

• Calcium and vitamin D supplements are usually required long-term.
• Synthetic PTH therapy may be considered in selected cases.

Lifestyle measures, such as maintaining a balanced diet and staying hydrated, can also help manage symptoms.

The parathyroid glands are essential for maintaining the body’s calcium balance and overall health. Disorders of these glands can have significant consequences if left untreated, but with early recognition, appropriate testing, and modern treatments, most people can achieve excellent outcomes.