Parathyroid Tumours

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

Anatomy of the Parathyroid Gland

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 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.

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 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.

Causes of Parathyroid Disease

Hyperparathyroidism

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

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

Symptoms of Parathyroid Disease

Hyperparathyroidism and Hypercalcemia symptoms 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

Hypoparathyroidism and Hypocalcemia symptoms 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.

Diagnosis of Parathyroid Disease

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