So, we just celebrated another birthday. We say to ourselves, “Hey, getting older is certainly better than the alternative.” But, as we get older things happen. Our muscles seem to appear to get weaker. We get fatigued more often and drowsy. We’re urinating much more, and our bones hurt. We think that this is something that just comes with age.
Well, sometimes it does; however, “This is the danger with hyperparathyroidism,” says Theodore Perry, MD. Dr. Perry performs about 150 thyroid and parathyroid procedures each year. “Many times, the symptoms of hyperparathyroidism mimic simple aging,” he added. In other words, many times the symptoms just mentioned, along with others, are caused by hyperparathyroidism. Other symptoms include osteoporosis and osteopenia, kidney stones, excessive urination, abdominal pain, depression or forgetfulness, bone and joint pain, frequent complaints of illness with no apparent cause, nausea, vomiting or loss of appetite, difficulty speaking or swallowing, and constipation. The most common symptom is a sudden increase in blood calcium levels which can only be determined with regular blood tests.
Hyperparathyroidism is when your parathyroid glands create too much parathyroid hormone in the bloodstream. These glands, located behind the thyroid at the bottom of your neck, area are about the size of a grain of rice. The parathyroid glands produce parathyroid hormone. This hormone helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.
The parathyroid glands maintain proper levels of both calcium and phosphorous in our bodies by turning the secretion of parathyroid hormone (PTH) off and on, much like a thermostat controls a heating system to maintain a constant air temperature. Vitamin D also is involved in regulating the amount of calcium in our blood.
Normally this balancing works well when calcium levels in our blood fall too low, the parathyroid glands secrete enough PTH to restore the balance. PTH raises calcium levels by releasing calcium from our bones and increases the amount of calcium absorbed by small intestine.
When calcium levels are too high the parathyroid glands produce less PTH, but sometimes one or more of these glands produce too much hormone. This leads to an abnormally high calcium level and low phosphorous levels in our blood. Calcium is best known for its role in keeping our teeth and bones healthy. But calcium also aids in the transmission of signals and nerve cells, and it’s involved in muscle contraction.
There are two types of hyperparathyroidism – primary and secondary. For the purpose of this article, we will discuss primary hyperparathyroidism, which occurs because of some problem with one or more of the four parathyroid glands:
- A noncancerous growth (adenoma) on a gland is the most common cause.
- Enlargement (hyperplasia) of two or more parathyroid glands account for most other cases
- A cancerous tumor in primary hyperparathyroidism is exceedingly rare.
Primary hyperparathyroidism usually occurs randomly but some people inherit a gene that causes the disorder, and is associated with Multiple Endocrine Neoplasia syndrome (MEN).
Complications
Complications of hyperparathyroidism are mainly related to the long-term affect of too little calcium in our bones and too much calcium in our bloodstream. Common complications include:
- Osteoporosis. The loss of calcium often results in weak, brittle bones that fracture easily.
- Kidney stones. Too much calcium in our blood may lead to too much calcium in the urine, which can cause small, hard deposits of calcium and other substances to form in the kidneys. A kidney stone usually causes major pain as it passes through the urinary tract.
- Cardiovascular disease. Although the exact cause-and-effect link is unclear, high calcium levels are associated with cardiovascular conditions, such as high blood pressure and certain types of heart disease.
So, how is hyperparathyroidism best determined? It is best determined by regular blood tests for calcium levels as well as a bone density scan, which can determine osteoporosis or osteopenia. Osteoporosis and osteopenia in men is rare and is usually caused by hyperparathyroidism.
What is the treatment?
For primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone. This causes high calcium levels in the blood, which can cause the variety of health problems discussed above. Surgery is the most common treatment for primary hyperparathyroidism and minimally invasive parathyroidectomy is the most common procedure performed. During this procedure, the surgeon removes the abnormal parathyroid glands, always leaving enough behind to regulate the normal calcium levels.. However, in most cases only one or two parathyroid glands are removed and usually the tumors are benign.
The benefit of the procedure is that the patient no longer has high calcium levels in the blood because the abnormal parathyroid glands have been removed. By eliminating the high calcium level in the blood, the patient will be protected from the short and long-term consequences of calcium elevation. The risks are minimal but might include either blood loss or infection. The patient may have short-term sore throat, or scratchy throat, but this is rarely permanent. Rarely, a patient might have a recurrence of hyperparathyroidism as the disease develops in a previously unaffected gland.
After the procedure people usually go home on the same day of surgery. The patient can start everyday activities in only a few days, and it takes only about one to three weeks to fully heal. Naturally, the surgery area must be kept clean and dry, and the patient may need to drink liquids and eat soft foods for a day. People usually recover soon after the surgery. Recovery may be fastest when less invasive techniques are used. Normally, osteoporosis and osteopenia cease progressing and in some cases those conditions actually improve. Patients normally feel a sense of renewed energy. They are no longer as fatigued as they had been in the past.
About Theodore Perry, MD
Theodore Perry, MD, is a general surgeon at Steward General Surgery in Vero Beach. His practice is located at 3790 Seventh Terrace, Suite 102, Vero Beach, Florida 32960. Call 772-559-5782 to schedule an appointment. Dr. Perry is board certified in general surgery and is a Fellow of the American College of Surgeons. He completed internship at Orlando Regional Medical Center in Orlando and residency at the Cleveland Clinic Foundation in Cleveland, Ohio, where he was appointed Chief Resident. Dr. Perry received his medical degree from the University of Florida in Gainesville.
He and his wife live in Vero Beach with many of their children and grandchildren.
To find a doctor or schedule an appointment, visit Steward DoctorFinder™.
