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HYPERPARATHYROIDISM

 

What Are Parathyroid Glands?

Unless you have parathyroid disease or know someone who has it, chances are you have never heard of the parathyroid glands. There are 4 small parathyroid glands, in the lower part of the neck behind the thyroid gland (parathyroid means next to thyroid) to the side of the breathing tube (trachea).  The parathyroid glands are hormone producing glands which makes them be a part of the endocrine system.

Parathyroid glands are responsible for regulating the calcium in the body. Calcium is a vital nutrient that is used by every single cell in the body for normal daily functions. It is responsible for transferring messages between nerves, building bones, signaling messages inside the cells themselves and so much more. If calcium levels are not exactly right, a variety of problems can occur, including bone loss, intestinal symptoms, kidney disease, and mental disturbances.  Essentially every cell and organ in the body will be inefficient and not function properly, which is why so many symptoms can occur with hyperparathyroidism.

  • The parathyroid hormone (PTH) eventually enters the bones and activates the cells that reabsorb and remodel the bone, thereby releasing calcium into the blood.
  • PTH will also instruct the kidneys to absorb calcium back from urine.
  • Finally, PTH changes Vitamin D to its active form, which helps the intestines absorb calcium from food, which increases the calcium in the blood.

When a patient develops primary hyperparathyroidism, this process is disrupted.

What is Primary Hyperparathyroidism?

 

The majority of the time, a parathyroid tumor is located in 1 of the 4 parathyroid glands. It is usually a benign tumor, called a parathyroid adenoma, which grows to an abnormal size. As it grows it releases greater amounts of PTH, thus causing Primary Hyperparathyroidism (PHPT).

Simply put, Primary Hyperparathryoidism is an excess of parathyroid hormone in the blood stream due to over activity of 1 or more of the parathyroid glands. It is the most common disease that affects the parathyroid glands. Hyperparathyroidism is a devastating disease that takes a toll on the entire body.

Parathyroid adenoma - Dr LarianA tumor develops within a parathyroid gland when there is a disturbance on the censor of a single parathyroid cell. The thermostat level (or censor) for the calcium changes to a higher number for that particular cell, while the remaining normal cells stay at the proper thermostat level. However, as the calcium in the blood increases, the normal parathyroid cells “turn off,” while the abnormal or bad parathyroid cell continues to produce PTH. The abnormal parathyroid cell begins to multiply and get bigger and the normal cells that are currently not active start to get smaller and shut down. Over time, the calcium level will increase until it reaches the set point on the thermostat of the parathyroid tumor cells.

Because hyperparathyroidism is caused by the abnormality of the censor, the elevated calcium level will continue to stay at the new “normal” level as long as the parathyroid tumor is in the body. This can lead to a variety of debilitating symptoms, including:

  • Weakening of the bones, causing osteoporosis and bone fractures;
  • Kidney stones, which can harm the overall function of the kidney;
  • Sluggish nervous system, leading to fatigue, memory loss, poor concentration, anxiety, and depression;
  • Stiffening of the blood vessels and high blood pressure;
  • Rhythm abnormalities in the heart and heart palpitations;
  • Intestinal issues such as acid reflux and constipation.

If left untreated for too long, hyperparathyroidism can significantly reduce your life expectancy and increase your risk to certain cancers, such as colon cancer, kidney cancer, breast cancer, and prostate cancer.

Unfortunately there is no medication to manage hyperparathyroidism; the only cure is surgery.

People with parathyroid diseaseWho gets Hyperparathyroid Disease?

 

100,000 new cases of PHPT are diagnosed every year. More specifically, 1 in every 800 people has PHPT, with the disease being more common in women, affecting 1 in every 250 women over the age of 60. Unfortunately, the majority of these people go undiagnosed or are misdiagnosed, as PHPT is a complex or confusing disease for inexperienced physicians.

Hyperparathyroidism Symptoms

 

Almost all hyperparathryoid patients experience symptoms of the disease. However, one of the reasons that so many hyperparathyroid patients go undiagnosed or are misdiagnosed is because the symptoms are wide-ranging, not necessarily overwhelming, and can be associated with several other diseases. Additionally, hyperparathyroidism affects every patient differently, making the disease hard to pinpoint for an inexperienced physician. For example, some patients will experience signs and symptoms of hyperparathyroid disease within the first year of having high blood calcium, while others will go 5 or more years without any obvious or debilitating symptoms. Regardless of the presence or absence of symptoms, the disease is still destroying your body, and ultimately decreasing your life expectancy if not treated. Luckily, the disease can be cured by removing the tumor with a minimally invasive procedure that usually takes less than 20 minutes.

“I struggled unsuccessfully for months to find a local surgeon who could diagnose my hyperparathyroidism, and was fortunate enough to learn about Dr. Larian while doing my own research. Few doctors are knowledgeable about parathyroid disease, even fewer can perform the surgery successfully using minimally invasive procedures.” –Jennifer, Washington DC

Every cell in our body uses calcium to function correctly; therefore having high calcium levels can cause a variety of symptoms. However, it is important to understand that the severity of symptoms does not necessarily correlate to the calcium level. This means you do not need to have highly elevated calcium levels in order to experience extreme symptoms, and, vice versa, you may have very high levels of calcium with little to no symptoms.

When you talk to a parathyroid patient, they will tell you that they no longer feel like themselves, they feel old, they have aches, they aren’t enjoying life like they used to, etc. For some patients, these symptoms are stronger and for others they are less pronounced. Because the spectrum of symptoms of hyperparathyroid disease is so diverse and patients can experience any combination of symptoms, a lot of patients are not properly diagnosed as having a parathyroid disorder, and continue to live in pain and discomfort. This is why it is crucial to find a parathyroid expert, like Dr. Larian, to correctly diagnose and treat the disease.

The overt symptoms of PHPT are generally, but not unanimously, considered to be:

  • Fragility fractures
  • Mental status change
  • Peptic ulcer disease
  • Kidney stones

Below is a more detailed list of the symptoms hyperparathyroid patients may suffer from as a result of the disease:

  • Chronic fatigue
    • Decreased energy levels
    • Don’t feel like leaving the house and participating in activities they used to enjoy
    • Always tired
  • Parathyroid symptomsJust don’t feel like yourself
    • Never feel 100% well
    • Don’t feel “normal” anymore
    • It is hard to explain to others, but you know you don’t feel right
  • Feel old
    • You are getting older, so this must be what it feels like to age?
    • Maybe it is just menopause?
  • Brain fog
    • Cognitive dysfunction
    • You can’t concentrate on simple tasks or big projects
    • Mental fogginess
    • Forgetfulness – you find yourself forgetting things easily
  • More irritable than usual
    • You aren’t as happy as you used to be
  • Depression
  • Anxiety
  • Reoccurring headaches
  • Poor sleep
    • You don’t sleep as well as you used to.
    • You can’t sleep through the night; wake up several times during the night
    • You have trouble falling asleep
  • Osteoporosis and Osteopenia
  • Bone pain
  • Bone fractures
  • Muscle weakness
  • Gastro-Intestinal problems
    • Acid reflux
    • Heartburn
    • GERD
    • Constipation
    • Peptic ulcer disease (stomach ulcer)
    • Anorexia
    • Acute pancreatitis
    • Abdominal pain (stomach aches)
  • Decreased libido (sex drive)
  • Kidney stones
    • Can potentially lead to kidney failure
  • Frequent urination
  • Excessive night time urination
  • Heart palpitations (arrhythmias)
  • High blood pressure

Long-standing elevation in calcium levels places a very heavy burden on your body. Parathyroid disease only gets worse with time for everyone, and will not get better on its own. Studies have found that patients who do not have their parathyroid tumor removed, experience a decrease in their life expectancy and ultimately pass away from kidney failure, heart failure, breast or prostate cancer, stroke, or heart attack. However, this does not need to be the case for you! When the parathyroid tumor is removed, the disease is completely cured in almost all cases.

“After years of vague symptoms and months of severe symptoms, just days after surgery I feel better than I have in such a long time.” -Jennifer  

If your calcium levels are even slightly higher than normal, it is time to find a parathyroid specialist, like Dr. Larian, who can properly diagnose you. Dr. Larian has unparalleled experience in diagnosing patients based off of their symptoms and calcium levels, and has seen countless manifestations of the disease. Many of Dr. Larian’s patients have gone years being undiagnosed or misdiagnosed by other physicians, and upon their first in-office, or even Skype, consultation with Dr. Larian he is able to instantly diagnose them. He will not tell you that your calcium is “not that high” or to “wait a few more months or another year to see if the levels come down” because he knows the parathyroid tumor will not go away on its on and therefore there is no reason to delay treatment.

PARATHYROID ADENOMA

Types of Parathyroid Tumors  

 

The most common type of parathyroid tumor is called a parathyroid adenoma, and is benign (non-cancerous). A parathyroid adenoma (or bad parathyroid gland) is a growth inside a parathyroid gland that causes the gland to produce excessive amounts of parathyroid hormone (PTH). Because the tumor forces the gland to make more and more PTH, the calcium levels in the blood increase, which is known as hypercalcemia. While a single adenoma is most common, it is possible to have parathyroid adenomas on several glands, or in rare cases in all glands.

Types of parathyroid adenomas

While the vast majority of patients only have a single parathyroid adenoma, it is very important to still conduct a 4 Gland Assessment to guarantee the patient is cured. Whether you have 1 parathyroid adenoma or 3 parathyroid adenomas, the signs and symptoms will be the same. Symptoms are not necessarily more extreme when a patient has multiple adenomas.

Over time the parathyroid tumor will continue to grow and your parathyroid disease will get worse until the tumor is removed. At the same time, your remaining normal parathyroid glands will stop working and can shrink in size over time. A parathyroid tumor will never go away on it’s own; it must be surgically removed. When performed by an expert parathyroid surgeon, like Dr. Larian, a minimally invasive parathryoidectomy is quick and successful cure for parathyroid tumors.

Interesting Parathyroid Adenoma Facts

  • Primary hyperparathyroidism develops over a period of years.
  • Calcium elevation usually plateaus with parathyroid adenomas, even though PTH levels continue to elevate.
  • Calcium levels do not correlate to the size of the parathyroid adenoma.
  • The size and weight of abnormal parathyroid gland(s) is directly proportional to PTH levels and inversely proportional to Vitamin D levels.
  • Degree and severity of hyperparathyroid symptoms does not always correlate to calcium levels.
  • Bone mass density loss occurs with all forms of hyperparathyroidism, even in Normocalcemic Hyperparathyroidism.
  • Bone mass density usually presents after 8 or more years of the disease process.

Customized 4 Gland Parathyroid Assessment

Once you are diagnosed with hyperparathyroidism, Dr. Larian needs to determine which parathyroid gland or glands is abnormal so that he can perform a focused and precise parathryoidectomy. He will perform a customized 4 Gland Parathyroid Assessment to ensure the disease is successfully cured. There are many modalities he can use to assess all of your parathyroid glands, including localization studies, intra-operative PTH testing, minimally invasive radio guidance, and, if necessary, 4 gland exploration.

Prior to surgery, Dr. Larian will have his parathyroid patients undergo localization scans (ultrasound, sestamibi scans, or 4-D CT scan) in order to determine the location of the parathyroid tumor. He believes in starting with the most minimally invasive and least potentially harmful scan, which is the neck/thyroid ultrasound to look for the parathyroid adenoma. An ultrasound has very good accuracy when performed by an expert ultrasoundagrapher or surgeon, and exposes the patient to lower levels of radiation when compared to a sestambi or CT scan. Dr. Larian performs ultrasound scans himself on his patients in his office, and has a very high rate of locating the tumor with this scan.

img_7134e-larian-with-patientIf the ultrasound is unable to locate the abnormal parathyroid gland(s), Dr. Larian will recommend a sestamibi scan. During a sestamibi scan, the patient is given a radiotracer that becomes absorbed by the abnormal parathyroid gland, so the location becomes visible. However, there are some significant limitations to sestamibi scans:

  • Results of the sestamibi scan are very dependent on the skill of the operator. An operator who is inexperienced with parathyroid disease may not have the skills to properly perform the scan.
  • Study results are only accurate if the first scan is done IMMEDIATELY after injection of the radiotracer.
  • Other tissues are sometimes picked up by the scan, which can lead to a false positive reading.
  • The sestamibi scan has a 20% degree of error, in which there are some cells that just do not pick up the sestamibi.
  • If the patient has one very large abnormal parathyroid gland, and a second abnormal parathyroid gland that is suppressed (because the other gland is so large), this smaller, yet still abnormal gland, often times does not show up on a sestamibi scan.

One of the newest scan options is the 4D CT Scan. This new technology is perhaps the most accurate and surgically helpful study. However, it presents the highest dose of radiation to the patient. Additionally, because it is a newer technology, a facility with a 4D CT scanner may not be available near you.

Many patients go undiagnosed because symptoms of parathyroid adenoma can be very vague or similar to the classic signs of aging, including fatigue, constipation, depression, anxiety, abdominal pain, kidney stones, fragility fractures, etc. The typical patient with a parathyroid adenoma will be cured of the disease immediately following parathyroid tumor removal surgery, as the calcium level will go back to normal within hours. Patients will be able to live a completely normal life with their three remaining parathyroid glands. Learn more about minimally invasive parathyroid tumor removal surgery with Dr. Larian.

Do You Need Parathyroid Surgery?

 

If you are suffering from hyperparathyroidism, the only cure is surgery. Dr. Larian is a world-renowned parathyroid surgeon who helps patients feel like themselves again. Do not wait any longer to be properly diagnosed with hyperparathyroid disease, and let us give you the treatment you deserve!

Consult With Dr. Larian Today.

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