A B C D E F G H I J K L M N O P R S T U V W

HYPERPARATHYROIDISM

What is Hyperparathyroidism ?

The parathyroids are four tiny glands, each the size of a rice grain. They are situated, two on each side, behind the thyroid gland, which sits low in the neck. Their function is to keep the calcium level in the blood at the correct level. They do this by producing a hormone (parathormone) which withdraws calcium from the bones as well as from the food in the bowel. In hyperparathyroidism (hyper = excessive, parathyroidism = parathyroid activity), one or more glands overproduce this hormone. The resulting raised calcium level in the blood may produce no symptoms at all: a high calcium level may be discovered accidentally when a blood test is taken for other purposes. Above a certain calcium level, however, lack of appetite, nausea, indigestion, tiredness and weakness may occur. Bone and joint pain, and even fractures, can develop. This is because calcium is leeched out of bones by the high level of parathormone. Overflow of calcium into the urine causes some people to develop kidney stones.

How does Hyperparathyroidism occur ?

Usually only one gland is overactive, due to the development of a benign tumour (adenoma). This produces the extra parathormone which has the various effects referred to above. Occasionally, more than one gland is overactive at the same time (hyperplasia). The end result as far as the patient is concerned is the same.

Why does Hyperparathyroidism occur ?

The cause of an adenoma is unknown. However, some cases appear to run in families: other members of your family may have hyperparathyroidism, or even overactivity of other glands. Overactivity of several parathyroid glands (hyperplasia) also runs in families. However, it may result from long-standing severe kidney failure. There is no way in which this condition could have been prevented.

Treatment Involved for Hyperparathyroidism

Sometimes it is necessary to find out which of the four glands is overactive. Ultrasound (a type of radar using sound waves) and special x-rays (CT scanning) or nuclear scans are sometimes useful for this. If you need an operation (see Parathyroidectomy), this type of information may be valuable to the surgeon, so he knows where to look. However, some surgeons feel that they are able to locate the abnormal gland(s) without such tests. When there are no symptoms an operation may not always be done. The decision may be helped by checking bone density (DEXA scan). If the bone mineral has been reduced by the parathyroid overactivity, an operation may be advised, even if the calcium level in the blood is only slightly raised. Alternatively, the doctor may simply check the blood-calcium level from time to time to be sure that it does not rise suddenly. If the calcium level is high, or if there are symptoms already present, operation is usual. This is a comparatively small procedure and has a higher than 90% chance of success in expert hands. Various drugs can also be used to treat a raised calcium level in the blood. This approach is usually not ideal for long-term treatment : drugs may lose their benefit and have side-effects.

During Treatment for Hyperparathyroidism

After successful operation, symptoms tend to improve rapidly, although some tiredness remains while the muscles and bones regain their strength. Immediately after operation, the blood-calcium level may briefly fall below normal, giving a tingling feeling in the hands and mouth. The doctor may give a type of vitamin D tablet to prevent this from happening and to help calcium to get back into the bones. If you have a mild state of hyperparathyroidism and if the decision not to operate has been made, careful follow-up will still be required. Calcium levels will need to be checked approximately every 3 to 6 months.

After Treatment for Hyperparathyroidism

Gradually, complete wellbeing is restored. Vitamin D preparations may be continued for a few months to help the bones. Most patients will not need long-term follow-up at all. In some cases, all the parathyroids will have been removed (particularly with hyperplasia). In that case, vitamin D, and perhaps calcium tablets must be taken lifelong. It will also mean that the your blood-calcium level needs to be checked carefully every few months. This is to be sure that the dose of vitamin D is correct. Calcium levels may run high because of too much vitamin D. This may not produce symptoms at the time, but can cause kidney damage. They may run low because of too little vitamin D, also without symptoms. This can cause cataracts in the eye if left untreated. As mentioned, if you have no symptoms to start with and only slightly raised calcium an operation may not be necessary. But you need to be aware that symptoms may develop in the course of follow-up. Please contact your doctor if any of the symptoms listed above develop.

If Hyperparathyroidism is Left Untreated

It is not certain whether patients without symptoms and with only barely raised levels of blood calcium suffer from not having treatment for their condition. However, it is possible that bones may gradually lose their strength, particularly in women after the menopause. If left untreated, patients already with symptoms and a higher calcium level can suffer increasing problems, including fractures, dehydration and kidney failure. Rare cases may develop coma due to the very high calcium content of the blood.

Effects on Family of Hyperparathyroidism

After surgical treatment, relatives will often notice that you are more alert and stronger. It may be important for them to remind you about having regular checks of your blood-calcium level if the doctors have decided that the calcium level in the blood is not high enough to justify an operation.