Ectopic Parathyroids
In most people, the parathyroid glands are located near the thyroid in the lower neck. However, in some cases, one or more glands can be located in unusual (ectopic) positions. These are known as ectopic parathyroid glands.
Understanding ectopic parathyroids is important, especially in cases of hyperparathyroidism when a gland cannot be located during surgery or imaging.
Quick Facts
- Occurs in about 15–20% of people
- Often discovered during surgery for hyperparathyroidism
- Most commonly found in the chest (mediastinum) or near the esophagus
How Do Ectopic Parathyroids Happen?
During fetal development, parathyroid glands form high in the neck and migrate to their normal position. Sometimes, this migration process is incomplete or misdirected, causing the glands to settle in unusual locations. These may include:
- Behind the esophagus
- Within the thyroid gland
- In the chest cavity (mediastinum)
- Near the carotid artery or thymus
Are There Symptoms?
Ectopic parathyroids don’t usually cause symptoms unless they become overactive (producing too much PTH). If so, the person may develop signs of hyperparathyroidism such as:
- High blood calcium
- Bone pain or weakness
- Kidney stones
- Fatigue or mood changes
How Are Ectopic Glands Found?
Locating ectopic parathyroid glands can be challenging. If one gland is “missing” during imaging or surgery, doctors may suspect it is in an ectopic location. Tools used for diagnosis include:
- Sestamibi Scan: A nuclear medicine scan that highlights active parathyroid tissue.
- CT or MRI: Especially useful for detecting glands in the chest or behind the neck structures.
- Ultrasound: Good for identifying glands in the neck but may miss deeper ectopic glands.
Surgical Challenges
In parathyroid surgery, not being able to find all four glands can indicate the presence of an ectopic one. Surgeons with experience in endocrine surgery are trained to explore potential ectopic sites if a gland is missing or not functioning normally.
Minimally invasive parathyroidectomy may not be sufficient in such cases, and open or extended exploration may be needed.
Note: Ectopic parathyroid glands are not abnormal or harmful by themselves, but they can complicate diagnosis and treatment if they become overactive. Accurate imaging and experienced surgical evaluation are key to successful management.