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Parathyroid

THE UNKNOWN GLAND: PARATHYROID

AN UNDERRECOGNIZED DISEASE: HYPERPARATHYROIDISM

The parathyroid gland consists of four small glands located in the neck, immediately adjacent to the thyroid gland, with two on each side. These glands produce a hormone called parathyroid hormone (PTH).

The primary function of parathyroid hormone is to maintain a stable calcium level in the blood. It does this by increasing the absorption of calcium from food and, when necessary, by releasing calcium stored in the bones into the bloodstream.

The most common disorder affecting the parathyroid glands is hyperparathyroidism. In this condition, one or more of the four glands produce parathyroid hormone uncontrollably. The excess hormone causes calcium to be released from the bones into the bloodstream, resulting in progressively elevated blood calcium levels.

Since the first effects of this condition occur in the bones, patients commonly complain of widespread bone and muscle pain, feeling unrested in the morning, and persistent fatigue. Because these symptoms are also common in rheumatic diseases, both patients and physicians may mistakenly pursue treatment for rheumatism for an extended period. Furthermore, bone density tests often reveal osteoporosis, leading to the incorrect prescription of calcium supplements, which can further increase already elevated calcium levels.

High blood calcium levels can have significant negative effects on the heart, particularly its electrical conduction system. Especially when calcium levels exceed 12 mg/dL, patients may develop cardiac arrhythmias, palpitations, hypertension, and in severe cases, sudden cardiac arrest. Patients with this condition should be admitted to the hospital immediately so their calcium levels can be rapidly lowered with medication.

Another serious consequence of elevated blood calcium is kidney damage. In female patients, particularly those with recurrent kidney stones, blood calcium and parathyroid hormone levels should always be measured to determine the underlying cause. Otherwise, even if the kidney stones are treated or broken up, they are likely to recur as long as blood calcium remains elevated.

High calcium levels can also cause digestive system problems such as gastritis and stomach ulcers, as well as psychological disorders, particularly depression.

As can be seen, hyperparathyroidism is an insidious disease that affects multiple organ systems and often hides behind the symptoms of many other medical conditions.

Once elevated calcium and parathyroid hormone levels are confirmed, the abnormal gland is located using neck ultrasonography and parathyroid scintigraphy.

Surgical removal of the diseased gland results in a dramatic improvement in the patient's symptoms. Bone and muscle pain disappear, while digestive and psychological symptoms may resolve within hours.

The operation is performed through a 2.5 cm incision on the side of the neck, and patients can usually return home the same day.