HEALTH MATTERS
By: Dr. Steven Kahn
Part of the endocrine system, the parathyroids are four small glands located in the neck. These glands secrete the vital parathyroid hormone and regulate calcium, i.e., how much calcium the body absorbs from our diet; the amount secreted by our kidneys, and how much is stored in our bones.
If one of these glands becomes overactive and produces too much parathyroid hormone, osteoporosis will occur, regardless of the age and gender of the patient.
Overproduction of the parathyroid hormone indicates that a tumor (almost always benign) has developed in one or more of the glands. Patients are often unaware that they have parathyroid disease because the symptoms are not severe. Once the diseased gland is removed, however, patients note that they feel much better and the loss of calcium stops.
Symptoms of parathyroid disease, also known as hyperparathyroid, are often categorized as "moans, groans, stones and bones." They may include:
symptoms of depression;
lack of interest in things that you used to enjoy;
"The surgeon can focus the operation on a small area of the neck and remove the diseased parathyroid while leaving the healthy glands alone." Steven Kahn, M.D.
Surgeon University Medical Center at Princeton |
decreased ability to concentrate or remember simple things,
aching bones, particularly in the legs and arms;
sleeplessness;
irritability;
acid reflux or heartburn;
peptic ulcer;
pancreatitis;
decreased interest in sex;
kidney stones;
high blood pressure (varying from mild to severe), and
osteoporosis.
The statistics regarding osteoporosis and parathyroid disease are worth noting.
All patients with a hyperparathyroid will develop osteoporosis. Women tend to develop it at faster rates than men do, and post-menopausal women generally develop osteoporosis two to five times faster than their peers. While there is no medicine that can prevent the worsening of osteoporosis, removing the diseased parathyroid usually stops the progression completely.
Of particular risk are post-menopausal patients with hyperparathyroidism as this combination proposes a "double whammy" of calcium loss.
How is a patient to know if he or she has parathyroid disease, especially when the symptoms can be attributed to a number of medical problems? The key to discovery lies in the blood.
Calcium levels are regulated by the parathyroid glands. When a patient has parathyroid disease, indicating that at least one of the parathyroid glands is overactive, the bones release a constant stream of calcium into the bloodstream. This results in a loss of bone density and hardness.
Measuring the amount of parathyroid hormone in the blood and comparing its level to the amount of calcium found in the blood is the way to detect parathyroid disease. A patient who has both a high blood calcium level and a high parathyroid hormone level has a diseased parathyroid.
Once a patient learns of the condition, treatment involves removal of the diseased gland.
Today the treatment of choice is gland removal via minimally invasive parathyroid surgery.
Until the mid-1990s, this was not possible. Before surgeons were able to detect which of the four glands was diseased before the operation began, a parathyroid operation required a large incision that exposed the entire neck and both sides of the thyroid. This inpatient procedure carries greater potential risk and requires a longer recovery period.
Recent medical advancements enable today’s surgeons to have a very good idea of which gland is diseased before the operation commences, making minimally invasive surgery possible. The surgeon can focus the operation on a small area of the neck and remove the diseased parathyroid while leaving the healthy glands alone.
Done as an outpatient procedure, this operation requires light general anesthesia. Typically, patients are feeling well the same day as the operation.
Perhaps the most important innovation, though, is the ability to take interoperative measurements of a patient’s parathyroid hormone levels.
Previously a surgeon had to wait 24 to 48 hours to measure a patient’s calcium level. For the last three years, however, a groundbreaking technique has made it possible for the surgeon to measure the parathyroid hormone level during the operation, both before and after gland removal. The surgeon will not leave the operating room until there is a greater than 50 percent reduction in the patient’s parathyroid hormone levels, thereby offering biochemical proof that there is a cure.
Immediately after the operation, the patient’s calcium level will begin declining. Some patients must take calcium pills to prevent their calcium levels from dropping too low. Having low calcium is a more dangerous condition than high calcium and its symptoms include cramps of the hands, wrist and feet, and tingling around the mouth and lips and in the fingertips.
Within a week or two, the parathyroid glands will once again begin controlling the calcium levels.
While minimally invasive parathyroid surgery is not always the recommended option (this depends on a specific patient’s special circumstances or anatomy), the vast majority of patients with parathyroid disease are good candidates.
When recommending this surgery to their patients, endocrinologists consider general health status, age, and bone density, identified parathyroid symptoms, calcium homeostasis and the availability of a surgeon who can perform minimally invasive surgery. Regardless of the type of surgery necessary, the important thing is to detect the condition and remove the diseased gland.
For more information on this little-known medical condition, visit www.parathyroid.com.
Steven Kahn, M.D., who routinely performs minimally invasive parathyroid surgery, is a board-certified surgeon on staff at University Medical Center at Princeton. This article was prepared in collaboration with Lorraine Seabrook.