The parathyroid gland is a set of approximately 4 small, pea-sized endocrine glands located behind the thyroid gland. They typically measure 2-3 mm in size and have a yellowish-brown color.
The parathyroid gland plays a crucial role in maintaining the body's calcium balance. If the parathyroid gland functions poorly (hypoparathyroidism),it can lead to a decrease in the calcium levels in the body.
Conversely, when the parathyroid gland is overactive (hyperparathyroidism),it results in an increase in calcium levels. Both conditions can lead to dysfunction in various organs. Therefore, it is essential for the parathyroid gland to produce hormones within normal limits, as deviations in hormone production can cause significant health problems.
The primary function of the parathyroid gland is to regulate calcium balance in the body by producing parathormone (PTH). Parathormone is one of the critical hormones responsible for maintaining calcium balance in the body. Irregularities in parathormone levels manifest with clinical symptoms in patients, and the diagnosis is made through screenings and tests.
Hyperparathyroidism is the most common parathyroid disorder. It occurs when one or more of the four parathyroid glands overproduce parathyroid hormone (PTH),leading to an elevation in blood calcium levels. This is achieved by increasing the release of calcium from the bones. As a result, symptoms such as bone pain, fractures, kidney stones, kidney disease, muscle weakness, high blood pressure, constipation, psychological problems, and others can occur.
In the case of the thyroid gland, the excess hormone production typically occurs in a single gland and is often due to benign tumors. This condition is referred to as parathyroid adenoma or primary hyperparathyroidism. The majority of hyperparathyroidism cases are primary in nature. Prolonged low calcium levels can lead to chronic kidney failure, known as secondary hyperparathyroidism.
In secondary hyperparathyroidism, if left untreated, one of the parathyroid glands may enlarge and produce parathyroid hormone independently of blood calcium levels. This condition is called tertiary hyperparathyroidism. The patient's blood calcium level and albumin level are evaluated together. Neck ultrasound (USG) is a highly accurate method for diagnosis. Parathyroid scintigraphy can also provide detailed examination. If these two methods do not yield adequate imaging, a CT scan or MRI may be performed.
The treatment for parathyroid gland disorders, including hyperparathyroidism, is typically surgical. In this procedure, the affected parathyroid gland is removed through surgery. Following parathyroid surgery, the patient's symptoms usually subside rapidly, and they can return to their normal social life within a very short period.
In necessary cases, calcium and vitamin D3 supplements may be administered after the surgery. Prior to the operation, it is crucial to determine the location of the diseased parathyroid gland using imaging methods. Accurate localization of the diseased parathyroid gland is highly important. With proper localization, the parathyroid gland can be removed with a small incision during the surgery. The postoperative hospital stay is usually brief and comfortable.
Hyperparathyroidism can be caused by benign adenomas, the enlargement of all glands (hyperplasia),or, rarely, by cancer. The majority of cases involve benign tumoral masses, and surgery is generally sufficient for treatment.
Hypoparathyroidism occurs when the level of calcium in the blood decreases due to reduced parathyroid hormone production, often as a result of the underactivity or damage to the parathyroid glands. Symptoms arise as a result of this decreased calcium level. One of the most common causes of hypoparathyroidism is the removal or damage of one of the parathyroid glands during thyroid surgery.
Early symptoms may include tingling and numbness in the fingertips and around the lips. As the condition progresses, muscle spasms may occur. Other symptoms can include shortness of breath, a feeling of constriction, dry skin, brittle nails, and hair loss.
Blood tests are conducted to measure calcium, phosphorus, and parathyroid hormone levels. If the blood calcium and parathyroid hormone values are low, and the phosphorus level is high, hypoparathyroidism is likely.
Hypoparathyroidism does not typically require surgical intervention. Instead, it is managed with medical treatment, and patients are closely monitored. Regular check-ups are used to adjust medication dosages, and patients are kept under observation.
The vast majority of tumors in the parathyroid gland are benign, with only around 1% being cancerous. When cancer is present, the calcium levels in the blood can rise significantly, and there is a higher likelihood of metastasis. The treatment for parathyroid cancer is surgical.
The symptoms of parathyroid cancer are similar to those of hyperparathyroidism. The diagnosis involves conducting a neck ultrasound (USG) and parathyroid scintigraphy to locate the tumor, after which a treatment plan is established. Surgery is the primary treatment for parathyroid cancer. In cases where there is no lymph node involvement, the tumor is typically removed along with the thyroid lobe on that side. In advanced cases, if the spread to neck lymph nodes is detected, these lymph nodes are also surgically removed.
Permanent hypoparathyroidism is a condition where the blood levels of parathyroid hormone (PTH) and calcium remain low for six months, leading to the development of associated symptoms. In such cases, the patient's medical treatment is regularly adjusted through check-ups.
We are committed to being with you during your treatment process for general surgery diseases with accurate diagnosis and effective treatment methods. Here, you can read the real experiences of my patients who share their health journey with me. Their sincere comments can be a guide for you as well.
Prof. Dr. Sezai AydınGeneral Surgery Turkey
PROF. DR. SEZAI AYDIN
