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Parathyroid

 The Unknown Organ: Parathyroid

The Unrecognized Disease: Hyperparathyroidism

The parathyroid gland consists of four glands, two on either side of the thyroid, and produces a hormone called ‘parathormone'.

The role of parathormone is to regulate blood calcium levels. It enables the absorption of calcium taken in through food and, when necessary, draws calcium out of the bones and gives it to the blood to compensate for any loss.

Hyperparathyroidism is the most commonly observed disease of the parathyroid gland. It is the excessive secretion of parathormone by one or more of the parathyroid glands which impacts the bones, causing them to release calcium into the blood. As a result, calcium levels in the blood gradually rise.

Since the effects are first seen in the bones, the patient will often complain of widespread bone and muscle pain, feeling run down in the mornings, and constant fatigue. As these symptoms can also be seen in rheumatic diseases, the patient may be misdiagnosed and given rheumatic treatment for a long period of time. Another important point is that a bone density test carried out under these circumstances will reveal osteoporosis. As a result, the patient may also be wrongly given calcium supplements which only further increase the already high levels of calcium.

The negative impact of high calcium levels on the heart and the heart's electrical conduction system is significant. Values above 12mg/dl, in particular, can lead to rhythm disorders, palpitations, hypertension and, in later stages, sudden cardiac arrest. Patients in this situation should be taken to hospital immediately and have their calcium levels brought down.

Another negative impact of high blood calcium levels is on the kidneys. When kidney stones - especially recurring ones - are detected in female patients, calcium and parathormone levels must be checked to determine the underlying cause. If blood calcium levels remain high, the kidney stones will recur even if they are treated.

High calcium levels also lead to problems associated with the digestive system such as gastritis and ulcers, in addition to psychological disorders like depression.

In other words, hyperparathyroidism can affect more than one system of the body and is the reason behind the symptoms of many diseases.

In the diagnosis of hyperparathyroidism, if calcium and parathormone levels are found to be high, the diseased gland is detected by performing a neck ultrasound and parathyroid scintigraphy.

With the surgical removal of the diseased gland, the patient's symptoms are dramatically improved. Bone and muscle pains disappear, as well as digestive and psychological disorders which can diminish within hours. Surgery is carried out with a 2.5-cm incision to the side of the neck and the patient can go home the same day.

The success of parathyroid surgery is dependent on the following factors:

•  A definitive diagnosis through laboratory tests (calcium levels in the blood/ calcium levels in urine over a 24-hour period / serum parathormone levels)

 

•  Localization of the diseased gland through imaging methods

•  Experience of the surgeon

•  Pathologically confirming, during surgery, that the removed gland is in fact the parathyroid gland

•  Measuring quick parathormone levels, during surgery, to confirm that there is no other diseased gland

 

 

 

 Video

 

Removal of the parathyroid gland using the minimally invasive method 

A 1-cm parathyroid adenoma located in the lower pole of the right thyroid lobe

In another patient, a 3-mm normal parathyroid gland (held with forceps) in the same localization

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