PARATHYROID DISEASE

What is Parathyroid Disease

The parathyroid gland is involved in regulating calcium.  When the parathyroid gland does not function correctly it can be associated with high or low calcium levels in the blood.

Parathyroid disease is associated with abnormal levels of Parathyroid Hormone (PTH).There are two main types of parathyroid disease:

  • Hyperparathyroidism (high parathyroid levels) which results in high calcium levels in the blood

  • Hypoparathyroidism (low parathyroid levels) which results in low calcium levels in the blood

What is the Anatomy of Parathyroid Disease

There are four small ‘pea sized’ lobes or glands that are located around the thyroid in your neck.

‘Para’ means ‘near’.  So ‘Parathyroid’ refers to the gland being near the thyroid.  

While the parathyroid glands are part of the body's endocrine system, the thyroid and parathyroid glands are completely different. The endocrine system consists of a range of glands that secrete hormones into the bloodstream.

What hormones help regulate calcium and phosphate

  • Parathyroid Hormone (PTH)

  • Vitamins D

  • Calcitonin

  • FGF-23

What does Parathyroid Hormone (PTH) do

Parathyroid Hormone (PTH) is a chemical that regulates the amount of calcium, phosphorus and magnesium in the bones and blood.  

  • High levels of PTH increases calcium in the blood

  • Low levels of PTH decreases calcium level in the blood

PTH works as a messenger and talks to other parts of the body to regulate calcium in the blood. This includes:

  • Bones- PTH controls how much calcium is pulled from the stores in the bone

  • Kidneys- PTH controls how much calcium is passed in the urine

  • Gut and intestines - PTH helps control vitamin D levels and much calcium is absorbed from the intestines.

How does Parathyroid Disease Affect You?

Every cell and organ in the body uses calcium as a signal to regulate their normal function. For example, calcium and phosphorus are important minerals and electrolytes that are crucial for:

  • Healthy bones

  • Muscle

  • Brain and nerve function

  • Controlling heart beat rhythm

  • Cell function

  • Making up the building blocks for DNA, cell membranes (walls) and ATP (energy)

Therefore, it is crucial that calcium levels are tightly controlled.

What are the Types of Parathyroid Disease

Hyperparathyroidism

  • Hyperparathyroidism is where the PTH levels are high which results in high calcium levels in the blood

  • Due to high PTH levels calcium can be “stolen” from the bone.

This condition can lead to:

  • High blood calcium levels (Hypercalcemia)

  • High urine calcium (Hypercalcuria)

Hyperparathyroidism can damage other organs in the body gradually and over time can cause:

  • Abdominal pain

  • Constipation

  • Kidney stones

  • Osteoporosis or weakened bones that puts you at higher risk of fractures

  • Mood disturbances

  • Fatigue

  • Pancreatitis (inflammation of the pancreas)

In severe elevations of blood calcium levels called "hypercalcemic crisis," a patient can become comatose or near-comatose due to organ failure.

Hypoparathyroidism

Hypoparathyroidism is characterised by low levels of PTH, this causes glands to drop hormone production, which decreases the amount of calcium in the blood.  This then affects nerve and muscle cells which are unable to function properly.

Hypoparathyroidism can cause:

  • Muscle cramps

  • Heart beat problems and arrhythmias

  • Bone problems

In children hypoparathyroidism can also cause:

  • Teeth failing to form, weak teeth or teeth that are slow to emerge

  • Impair mental development

Who are is at Risk of Parathyroid Disease

Parathyroid disease can be associated with:

  • Family history of hormone problems

  • Autoimmune disease (when your body’s defense system attacks your own cells)

  • Radiation therapy to your head or neck

  • Chronic kidney disease

  • Other electrolyte problems such as low levels of magnesium in the blood

  • Inherited gene mutations such as MEN (Multiple Endocrine Neoplasia).  People with MEN can get calcium problems at a young age.

  • Older age

What is Multiple Endocrine Neoplasia

MEN is associated with tumors in the:

  • Parathyroid glands

  • Pituitary

  • Pancreas

  • Adrenals

  • Thyroid

Hyperparathyroidism is very common in Multiple Endocrine Neoplasiaand occurs in almost all patients.

What are the Causes of Parathyroid Disease

Hyperparathyroidism can be caused by:

  • Small tumour (adenoma) in the gland.

  • Chronic kidney (renal) disease

  • Particular medications, such as anticonvulsant drugs and lithium

  • Genetic disorders such as multiple endocrine neoplasia

Hypoparathyroidism can be caused by:

  • Magnesium deficiency

  • Injury to the gland

  • Surgery on the nearby thyroid gland

  • Genetic disorders

  • Congenital conditions where people are born without parathyroid glands

  • Autoimmune conditions

What ARE Symptoms of Parathyroid Disease

Symptoms of Hyperparathyroidism and hypercalcemia may include:

  • Pain in the bones and joints

  • Increased susceptibility to bone fractures

  • Shrinking height

  • Backache

  • Muscle aches

  • Thirst

  • Frequent urination

  • Abdominal pain

  • Fatigue

  • Nausea

  • Loss of appetite

  • Depression and other personality changes

Symptoms of hypoparathyroidism and hypocalcemia may include:

  • Pins and needles

  • Brittle hair and nails

  • Dry, roughened skin

  • Muscle cramps and spasms

  • Convulsions

Can people with Parathyroid Disease have no symptoms?

Yes .

People with mild parathyroid disease may not initially notice any symptoms and the condition. Instead it may be picked up by chance on:

  • Calcium blood test

  • Kidney scan showing kidney stones

  • Bone density showing weak bones

Later, if the parathyroid disease is not treated properly they may notice significant problems. If not treated early sometimes it can lead to irreversible complications.

How is Parathyroid Disease Diagnosed

Diagnosing parathyroid disease can be made easily by checking simple blood tests including:

  • PTH levels

  • Calcium

  • Other electrolytes such as magnesium and phosphate  

  • Renal function

Some patients are diagnosed with  parathyroid disease incidentally by chance on a blood test whilst others may be picked up on screening for osteoporosis whilst others may have have non-specific symptoms.  Whatever the reason, all types of hyperparathyroidism and hypoparathyrodism can be picked up by checking a PTH level.

Hyperparathyroidism

Diagnostic test for hyperparathyroidism include:

  • High PTH levels in blood

  • High calcium levels in blood

  • High calcium levels in urine

  • Other electrolytes in blood like phosphorus or magnesium may be abnormal

  • Bone x-rays usually show low bone density or osteoporosis

  • Kidney function may be abnormal

  • Kidney scans may show kidney stones

  • Biopsy of parathyroid - a small tag of tissue may be removed by needle and analysed under microscope may show either parathyroid hyperplasia or adenoma

  • Sometimes gene tests can be performed to check for conditions that cause high calcium like Multiple Endocrine Neoplasia

  • Scans of the parathyroid gland such as ultrasound or 4DCT looking for enlarged parathyroid glands

  • Sestamibi scans of the parathyroid gland looking to see if the parathyroid glands that are working overdrive

Hypoparathyroidism

Diagnostic test for hyperparathyroidism include:

  • Low PTH levels in blood

  • Low levels of calcium in blood

  • Other electrolytes in blood like phosphorus or magnesium may be abnormal

  • ECG to check for heart arrhythmia (irregular heartbeat)

What If Parathyroid Disease is Not Treated?

  • If a diagnosis of any Parathyroid disease is made and is not treated it can have serious consequences for the patient’s health.

  • Depending on the condition untreated, parathyroid disease can lead to worsening symptoms, organ damage such as kidney failure, heart problems or bone fractures. In severe disease that is untreated it can even cause death.

How is Parathyroid Disease Treated

Hyperparathyroidism

  • Close monitoring by an endocrinology specialist

  • Medications that improve bone health

  • Surgery to remove an abnormal parathyroid gland (Parathyroidectomy)

Hypoparathyroidism

  • Close monitoring by an endocrinology specialist

  • Oral calcium carbonate tablets to increase calcium levels

  • High dose Vitamin D to help your body absorb calcium.

  • Parathyroid hormone Injections

  • Intravenous infusion in the case of immediate symptom relief

Hypocalcaemia

  • Close monitoring by an endocrinology specialist

  • Dietary supplement of or with calcium tablets

  • Activated Vitamin D supplementation