Parathyroid glands are very small endocrine glands, which produce parathyroid hormone (PTH). Most people have four glands, which are often located in the neck with close relation to thyroid gland. However, in some people their location can be quite variable which can be in other areas of the neck or rarely in the chest. PTH with it’s interactions with gut, bones, kidneys and Vitamin D keep the body calcium levels in balance.
Individuals with a problem in their parathyroid glands are detected by number of ways:
– Unexpected finding of high calcium in a blood test
– Investigations of weak bones, kidney stones, pancreatitis, etc.
– Investigations of non-specific symptoms such as, aches and pains, tiredness, constipation, depression, confusion etc.
When the parathyroid hormone over production is due to primary problem in the parathyroid glands it is known as PHPT.
In up to 85- 90% this is due to one abnormal gland known as adenoma. There are number of tests such as neck ultrasound, radioisotope scan known as sestamibi or 4D parathyroid CT which can locate this single adenoma which then can be removed.
In others there may be more than one adenoma or all the glands can be enlarged which is known as hyperplasia.
Patients with mild PHPT with no symptoms can be observed but the others with following features will benefit from surgery:
– Kidney stones, weak bones (osteoporosis or worsening osteopaenia), pancreatitis etc
– Symptoms that affect quality of life
– High calcium levels
– Younger patients
When the parathyroid hormone over production is a reaction of the parathyroid gland to another condition such as kidney failure it is known as Secondary Hyperparathyroidism and some of these patients may also benefit from surgery.
Minimally Invasive Parathyroidectomy (MIP):
This is when a localized parathyroid adenoma is removed via a small 2 cm incision in the neck
Four-gland neck exploration:
This is when neck is explored through a midline small incision to identify all the parathyroid glands and remove the abnormal ones. It is used when localization studies have failed to identify an abnormal gland and/or there is suspicion of multiple abnormal glands.