What is the parathyroid gland?

There are four parathyroid glands in the neck, usually attached to the thyroid gland. They control the calcium levels in the blood, which is important for a wide array of functions throughout the body. The most common problem with parathyroid glands is an overactive gland due to a benign tumour called primary hyperparathyroidism. In 90%+ of cases, only one gland is involved.

The surgery of the parathyroid glands involves locating the diseased parathyroid gland, either with imaging before surgery or by a neck exploration at surgery. If the abnormal gland(s) are found on imaging prior to surgery, then a minimalist targeted approach to removing the abnormal gland can be undertaken. If they cannot be found or disease is due to multi-gland disease, then a bilateral neck exploration is undertaken and the abnormal glands removed.

What are the main functions of the parathyroid gland?

The parathyroid glands control the level of calcium in the bloodstream, bones and rest of the body. They do this by producing a hormone called PTH (Parathyroid Hormone). Calcium is needed in the body for the following:

• To provide energy for the nervous system
• To give energy to our muscles
• To strengthen our bones

If calcium levels are too low, the parathyroid glands will release more PTH, and if there is enough calcium in the body, they will temporarily stop releasing PTH. If the parathyroid glands are diseased, then this leads to certain problems.

Complications with the parathyroid gland

There are three main problems that can develop in the parathyroid glands: hyperparathyroidism, hypoparathyroidism and cancer.

• Hyperparathyroidism: when calcium levels in the blood are too high as a result of the parathyroid glands overproducing PTH. The symptoms are varied, including osteoporosis, kidney stones, excessive urination, abdominal pain, tiredness or weakness, depression or lack of memory, pain in the bones and joints, nausea, vomiting and loss of appetite.
• Hypoparathyroidism: when calcium levels are too high in the bloodstream, as a result of too little PTH being produced. Low calcium levels lead to an excess of phosphorus in the blood. Symptoms can include numbness around the mouth, hands or feet, spasms, anxiety or depression, fatigue, and rough or brittle hair.
• Cancer: cancerous growths on the parathyroid glands can cause symptoms such as muscle weakness, difficulty swallowing and a lump in the neck. Parathyroid gland cancer can also result in hypercalcaemia, which can cause people to feel thirsty often, excessive urination, tiredness, indigestion, loss of appetite, constipation and muscle weakness.

Are there any treatments for parathyroid gland problems?

• Hyperparathyroidism: treatment for this includes a ‘watch and wait’ approach, medications to reduce calcium levels, and to combat osteoporosis, as well as surgery to remove the diseases glands. Lifestyle changes can also help, such as diet changes, exercising regularly, drinking enough fluids and stopping smoking.
• Hypoparathyroidism: the objective is to restore the balance of calcium and phosphorus in the body. It can be treated with calcium carbonate and vitamin D supplements, in addition to PTH injections if the specialist deems it appropriate.
• Cancer: the most effective treatments are surgery, radiotherapy and chemotherapy for parathyroid gland cancer.

What specialist treats parathyroid gland problems?

The specialists who treat parathyroid gland problems are endocrinologists, surgeons, endocrine surgeons, and ENT surgeons.