Endocrine, Gallbladder, Hernia and General Surgeon
Over active parathyroids are the main cause of parathyroid disease and a high blood calcium. We have 4 of these glands because they are so important. We only need one to function normally so have 3 spare! Parathyroid tumours usually affect 1 of the 4 parathyroid glands. We offer 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 London Zoo in 1852. It wasn't till 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 Mr Kirkby-Bott.
is the over expression of a hormone call PTH (parathyroid hormone). PTH fine tunes the blood calcium level as 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. Objectively this can cause kidney stones as having a high concentration of calcium in your urine can make kidney stones that cause pain and or recurrent urine infections. It is also important in bone strength and overactive parathyroids secrete a lot of PTH which takes calcium out of the bone and into the blood reducing your bone mineral density and increasing the risk of osteoporosis and bone fractures. This 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 can cause 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% of patients having surgery report a significantly improved quality of life after surgery.
Primary Hyperparathyroid disease
This disease can occur in any adult. It is more common in women though and the peak incidence is in their 50s-70s. Because the general symptoms could be described as a part of many illnesses it takes on average 3 years after the first presentation with these symptoms to get a diagnosis and treatment. Onset is insidious so sufferers, and those they see most days often, don't notice the changes it causes at first. Friends and relatives you see once or twice a year often do notice over a few visits and then the symptoms mimic so many other diseases that even after seeing a doctor it can take a long time to make a diagnosis. This disease causes a benign (not cancer) enlargement of a parathyroid gland known as an adenoma. Once a biochemical diagnosis is confirmed with blood and urine tests, localising the adenoma with an ultrasound and a Sestamibi scan can direct surgery so it is minimally invasive or focussed.
Rarer forms of hyperparathyroidism are caused by renal failure in patients that are dialysis dependent known as secondary hyperparathyroidism. Those that have had renal failure reversed by a kidney transplant can develop tertiary hyperparathyroidism. Secondary and tertiary hyperparathyroidism are a multi-gland disease. A rare genetic disease called MEN 1 (and sometimes MEN 2) get a multi-gland disease too. These are treated by finding all 4 glands and removing the most diseased looking 3 and leaving a normal size remnant of the fourth. Surgery for these often recurs rather than is cured. The surgeon aims to maximise the time to recurrence (aim 10-15 years) and make subsequent surgery less complex and safer. We rarely remove all 4 glands as it can cause a painful, weak bone complaint called 'adynamic bone disease'.
Underactive parathyroid disease is caused by complications of previous neck surgery such as post thyroidectomy or very very rare genetic complaints. Vitamin D and calcium replacement are the treatment. Surgery rarely helps.
What is Minimally invasive Parathyroid 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 a 2-3cm incision in the neck over where the gland is. It is done under a general anaesthetic and nerve block to smooth recovery. It carried out as a day case. Frozen section and intra-operative PTH measurement can have a role in a few cases, but don't reduce the risk of failure by any more than an additional 1%. The chance of surgery being successful in first time surgery is around 96-97% without using them.
No operation is without some risks and these are discussed here.
Post operation advice for parathyroid surgery can be found here