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We have 4 parathyroid glands because they are so important. We only need 1 or 2 to function normally, and we have 2-3 spare!
Both overactive (hyper) and underactive (hypo) parathyroids can cause disease conditions. Hyperparathyroidism and Hypoparathyroidism are distinct syndromes with different symptoms, risks and treatments. We offer expert on advice on the investigation, diagnosis and treatment of these conditions.
Dr Richard Owen was the first to identify the Parathyroid gland. He found them in an Indian Rhinoceros at the London Zoo in 1852. It wasn't until the 1980's that the role of PTH in fine-tuning blood calcium levels was demonstrated in the US.
In 2011, their normal size was first described in a study by our Consultant Surgeon Mr James Kirkby-Bott.
Usually when we talk about Hyperparathyroidism, we are talking about Primary Hyperparathyroidism or Primary HPT.
PTH fine tunes the blood calcium level - very tight control is needed for efficient bodily function. As calcium is an important part of cell signalling, muscle contraction, neurone (nerve) function and skeletal strength, a high blood calcium can have lots of effects on the body. Having a high concentration of calcium in your urine can make kidney stones that cause pain and or recurrent urine infections.
PTH is also important for bone strength and overactive parathyroids secrete a lot of PTH which takes calcium out of the bone and into the blood. This reduces your bone mineral density and increases the risk of osteoporosis and bone fractures. Hyperparathyroidism can make osteoporosis worse and develop at a younger age.
Because calcium levels are important to muscle and nerve function, as well as telling cells what to do, you can get generalised symptoms such as tiredness. Excessive thirst and excessive urination that keeps you up at night can worsen this. Muscle (rather than joint) aches and pains, an upset tummy and abdominal pains can occur. It often causes a fogging of the brain with altered concentration, poor memory, anxiety, depression and emotional lability (flying off the handle or crying for no reason).
These symptoms can be reversed by successful surgery. It is important to note here that a lot of these symptoms can come from modern life. They won't all get 100% better. Population based studies though have shown that more than 70-80% of patients having surgery report a significantly improved quality of life after surgery.
This operation is used for successfully localised primary hyperparathyroidism where we know where the abnormal gland is. It is the operation we usually offer in over 95% of cases.
It is carried out as a day case and a 2-3cm incision is made in the neck over where the gland is. It is done under a general anaesthetic and nerve block to smooth recovery.
A frozen section procedure and Intra-Operative PTH monitoring can have a role in a few cases, but they don't reduce the risk of failure by any more than an additional 1%. The chance of parathyroid surgery being successful the first time is around 96-97% without using these.
No operation is without some risks and these are discussed here.
Post operation advice for parathyroid surgery can be found here