By Omodele Hogan, MD
The four tiny parathyroid glands located at the base of your neck behind your thyroid may be small in size, but they make up for it in function.
Their sole purpose is to regulate the calcium levels in your bloodstream, which affects your bones, kidneys and intestines.
And when one or more of the glands becomes overactive — a condition called primary hyperparathyroidism — it can cause a wide range of problems.
The Center for Thyroid & Parathyroid Care at Penn Medicine Princeton Medical Center offers expert care for patients with thyroid or parathyroid conditions, including hyperparathyroidism.
Understanding Primary Hyperparathyroidism
Each about the size of a lentil, the parathyroid glands produce a hormone that helps maintain the right balance of calcium in your blood. Calcium is important for good health, keeping your bones strong, and ensuring your heart, muscles and nerves work properly.
However, in the case of primary hyperparathyroidism, one or more of the glands go into overdrive and make too much of the hormone, triggering your bones to release extra calcium into the blood and signaling to your intestines to absorb more calcium from the food you eat.
Further, the increased calcium puts an added burden on your kidneys, which need to work overtime to flush out the excess mineral.
Primary hyperparathyroidism is one of the most common hormonal disorders, affecting about 100,000 people in the United States each year, according to the National Institutes of Health.
While the exact cause is unknown, in about eight out of 10 people with primary hyperparathyroidism, a benign or noncancerous tumor has formed in one of the glands, according to the National Institutes of Health.
Primary hyperthyroidism is diagnosed in women more than in men, and most often in people over age 60, though it can also occur in young adults.
Symptoms and Complications
Most people with primary hyperparathyroidism have no symptoms, but when symptoms do occur they can include:
• Excessive thirst
• Excessive urination
• Bone or joint pain
• Abdominal pain
While these symptoms can be a sign of primary hyperthyroidism, they are also associated with many other medical conditions. That is why it is important to see your doctor for an evaluation.
If primary hyperparathyroidism is left uncontrolled, it can lead to serious complications including:
• Kidney stones
• Long-term kidney disease
• High blood pressure and heart disease
Diagnosis and Treatment
When primary hyperparathyroidism is suspected, specific blood tests, a 24-hour urine test, along with a bone density scan are the first steps toward a diagnosis. Additionally, an X-ray or ultrasound may be ordered to check for kidney stones.
If the condition is confirmed, further imaging tests are used to identify the overactive gland.
Treatment for primary hyperparathyroidism varies depending on its severity. In people with mildly elevated calcium levels, who have no symptoms, surgery is not typically recommended.
Instead, individuals are encouraged to:
• Do weight-bearing exercises regularly to keep bones healthy and strong.
• Talk to their doctor if they are taking a type of water pill called a thiazide diuretic, as it may be helpful to switch to one that does not impact calcium levels.
• Drink plenty of water to prevent kidney stones from forming.
• Maintain a moderate amount of calcium in their diet. A low calcium diet can make matters worse.
Individuals who are experiencing symptoms or have moderate to severely high calcium levels are usually treated through a minimally invasive surgical procedure to remove the malfunctioning gland or glands.
Because surgery is minimally invasive, most patients, including older patients, are able to promptly resume their normal activities. Over time, the remaining healthy glands usually take over the function of the gland or glands that have been removed.
It is important to note that if you have primary hyperparathyroidism, it is typically recommended that you maintain a moderate amount of calcium in your diet. You may also need to take a vitamin D supplement, as low vitamin D can further stimulate the parathyroid glands to make even more hormones.
At the Center for Thyroid & Parathyroid Care at Penn Medicine Princeton Medical Center, care is provided by a multidisciplinary team of endocrinologists, endocrine surgeons, radiologists, anesthesiologists, and specially trained nurses.
All patients at the center are offered complimentary nurse navigation services. The nurse navigator is an experienced registered nurse who is a dedicated resource, available to assist in coordinating every aspect of care and recovery, and to help patients and their families understand their diagnosis and treatment plan.
The goal of the center is to provide a streamlined transition from diagnosis through recovery, and to facilitate the best surgical quality and safety using national guidelines.
For more information about the Center for Thyroid & Parathyroid Care at Penn Medicine Princeton Medical Center, call 609-853-6050.
To find a physician with Penn Medicine Princeton Health, call 888-742-7496 or visit www.princetonhcs.org.
Omodele Hogan, MD, is board certified in endocrinology, diabetes, and metabolism, and is a member of the medical staff at Penn Medicine Princeton Health.