Parathyroid

The parathyroid gland is the four pea-sized glands that are located near the thyroid gland in the neck. They release the parathyroid hormone that is responsible for maintaining the calcium level in the body.

It performs the following functions:

  • Calcium conservation by kidneys.
  • Bones release calcium into the blood.
  • Intestines absorb the calcium from the food.
  • Activates cells in the kidney to convert a weaker form of vitamin D into the strongest by absorbing calcium from the intestine.

The parathyroid disease affects the parathyroid gland and it is of three types:

  • hyperparathyroidism
  • parathyroid cancer
  • hypoparathyroidism

Hyperparathyroidism (HPT)

It is one of the most common types of parathyroid disease in which one or more glands are hyperactive and make excessive PTH. This results in hypercalcemia – a condition in which the calcium increases in the blood. It is usually discovered in people between the age of 50 and 60 and more women are affected by it than men. Hyperplasia is a condition in which two or more glands are hyperactive.

Usually, people with HPT have no initial symptoms but some mild symptoms can be –

  • Depression
  • Tiredness
  • Increase in sleep requirement
  • Weakness in muscle
  • Joint and bone pain

People who have the more severe diseases have these symptoms –

  • Nausea
  • Vomiting
  • Constipation
  • Impaired thinking
  • Frequent urination and thirst
  • Appetite loss

Parathyroid Cancer

It is a very rare disease that affects people in their 50s and can cause HPT. It can reappear at the same point from where it started even after treatment. By taking measures to control the calcium level, recurrence can be slowed. The key to survival is the early discovery of the same.

Hypoparathyroidism

It is a condition in which the body does not produce sufficient PTH and the calcium level in the blood is excessively low. This usually happens when the parathyroids are damaged or neck surgery has been performed. Autoimmune attack on the gland can also result in the same.

The risk posed due to hypoparathyroidism are:

  • Addison’s disease
  • Parkinson’s disease
  • Cataract
  • Pernicious anemia

Diagnosis

To diagnose parathyroid disease, the doctor may ask to undergo any of the following tests:

  • Calcium blood test
  • Calcium in urine test
  • Parathyroid hormone (PTH) test
  • Vitamin D test

To check complications after diagnoses, the following test can be done:

  • MRI - body
  • CT Scan - body
  • Ultrasound
  • DEXA or DXA
  • 25-hydroxy-vitamin D blood test

Treatment of parathyroidism

Treatment of parathyroidism includes the following:

  • Surgery
  • Monitoring
  • Medication
  • Dietary Supplements

Surgery

It is one of the most effective ways to treat parathyroidism. It removes the hyperactive parathyroid gland which helps to increase bone density, fewer chances of fracture and kidney stone formation.

Before carrying out the surgery, doctors may ask to undergo the following tests:

  • Ultrasound
  • Four-dimensional CT (4DCT)

Monitoring

People who have mild initial HPT can be monitored safely without undergoing any surgery.

Monitoring includes –

  • Timely physical exams
  • Measurement of bone density
  • Blood tests to check kidney functions and calcium levels

It is advised by the doctors when –

  • A person shows no symptoms
  • A person has normal kidney function and bone density
  • Moderately high blood calcium levels

Medication

To reduce the PTH production by the parathyroid gland, a medication called calcimimetics is advised. To treat primary HPT due to parathyroid cancer and secondary HPT due to dialysis, Cinacalcet is approved.

Dietary Supplements

People who have undergone surgery for parathyroid tissue removal and have a low level of calcium need to take calcium supplements throughout life. Vitamin D supplements are prescribed to people with primary HPT. Calcium is given endovenously to people who have prolonged muscle contractions and life-threatening attacks of low calcium levels.