Parathyroid Disease (Hyperparathyroidism) treatment in India

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What is Hyperparathyroidism?

Parathyroid Disease (Hyperparathyroidism) is when your parathyroid glands create too much parathyroid hormone in the bloodstream. These glands, located behind the thyroid at the bottom of your neck, are about the size of a grain of rice. The parathyroid glands produce parathyroid hormone. This hormone helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning.

Two types of Hyperparathyroidism

Primary hyperparathyroidism

Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands:

• A noncancerous growth (adenoma) on a gland is the most common cause.
• Enlargement (hyperplasia) of two or more parathyroid glands accounts for most other cases.
• A cancerous tumor is a very rare cause of primary hyperparathyroidism.
• Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.

Secondary hyperparathyroidism

Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. This causes your parathyroid glands to overwork to compensate for the calcium loss. Factors that may contribute to secondary hyperparathyroidism include:

• Severe calcium deficiency. Your body may not get enough calcium from your diet, often because your digestive system doesn't absorb the calcium from it.
• Severe vitamin D deficiency. Vitamin D helps maintain appropriate calcium levels in the blood. It also helps your digestive system absorb calcium from your food.
• Your body produces vitamin D when your skin is exposed to sunlight. You also consume some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.
• Chronic kidney failure. Your kidneys convert vitamin D into a form that your body can use. If your kidneys work poorly, usable vitamin D may decline and calcium levels drop, causing parathyroid hormone levels to go up. Chronic kidney failure is the most common cause of secondary hyperparathyroidism. Some medical treatments, such as vitamin D, bisphosphonates and cinacalcet, will lower PTH levels.

Symptoms and Causes

Too much calcium in the blood (hypercalcemia) can cause a number of symptoms and medical conditions. These include:

• Fatigue.
• Worsening memory and concentration.
• Depression, irritability or mental confusion.
• Kidney stones.
• Bone and joint pain, osteoporosis.
• Abdominal pain.
• General aches and pains from no obvious cause.

Risk Factors

You may be at a high risk of primary hyperparathyroidism if you:

• Are a woman who has gone through menopause
• Have had prolonged, severe calcium or vitamin D deficiency
• Have a rare, inherited disorder, such as multiple endocrine neoplasia, type 1, which usually affects multiple glands
• Have had radiation treatment for cancer that has exposed your neck to radiation
• Have taken lithium, a drug most often used to treat bipolar disorder

Diagnosis

Blood tests

If blood test results show you have high calcium levels in your blood, your doctor will likely repeat the test to confirm the results after you haven't eaten for a period of time. Many conditions can raise calcium levels. But your doctor can diagnose hyperparathyroidism if blood tests show you also have high levels of parathyroid hormone.

Additional diagnostic tests

Bone mineral density test. This test is done to see if you have developed osteoporosis. The most common test to measure bone mineral density is dual energy X-ray absorptiometry (DEXA). This test uses special X-ray devices to measure how many grams of calcium and other bone minerals are packed into a bone segment.

Urine test. A 24-hour collection of urine can provide information on how well your kidneys work and how much calcium is excreted in your urine. This test may help in judging the severity of hyperparathyroidism or diagnosing a kidney disorder causing hyperparathyroidism. If a very low calcium level is found in the urine, this may mean it's a condition that doesn't need treatment.

Imaging tests of kidneys. Your doctor may order an X-ray or other imaging tests of your abdomen to determine if you have kidney stones or other kidney abnormalities.

Imaging tests before surgery

If your doctor recommends surgery, he or she will likely use one of these imaging tests to locate the parathyroid gland or glands that are causing problems:

Sestamibi parathyroid scan. Sestamibi is a radioactive compound that is absorbed by overactive parathyroid glands and can be detected by a scanner that detects radioactivity.

The normal thyroid gland also absorbs sestamibi. To eliminate uptake in the thyroid obscuring the uptake in a parathyroid adenoma, radioactive iodine, which is only taken up by the thyroid, also is given and the thyroid image is digitally subtracted. Computerized tomography (CT) scanning may be combined with the sestamibi scan to improve detection of an abnormality.

Ultrasound. Ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue. A small device held against your skin (transducer) emits high-pitched sound waves and records the sound wave echoes as they reflect off internal structures. A computer converts the echoes into images on a monitor.

Treatment

Your doctor may recommend no treatment and regular monitoring if:

• Your calcium levels are only slightly elevated
• Your kidneys are working normally, and you have no kidney stones
• Your bone density is normal or only slightly below normal
• You have no other symptoms that may improve with treatment
• If you choose this watch-and-wait approach, you'll likely need periodically scheduled tests to monitor your blood-calcium levels and bone density.

Surgery

Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases. A surgeon will remove only those glands that are enlarged or have a tumor. If all four glands are affected, a surgeon will likely remove only three glands and perhaps a portion of the fourth — leaving some functioning parathyroid tissue.

Surgery may be done as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery can be done through very small cuts (incisions) in the neck, and you receive only local anesthetics.

Risks Involved in Surgery

• Damage to nerves controlling the vocal cords
• Long-term low calcium levels requiring the use of calcium and vitamin D supplements

Hormone replacement therapy. For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium. This treatment doesn't address the underlying problems with the parathyroid glands. Prolonged use of hormone replacement therapy can increase the risk of blood clots and breast cancer. Work with your doctor to evaluate the risks and benefits to help you decide what's best for you. Some common side effects of hormone replacement therapy include breast pain and tenderness, dizziness, and headaches.

Bisphosphonates. Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism. Some side effects associated with bisphosphonates include low blood pressure, a fever and vomiting. This treatment doesn't address the underlying problems with the parathyroid glands.

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Frequently asked questions

Q.What are the side effects of parathyroid?

• New or unusual pain that is ongoing;
• Swelling or tender lumps under your skin;
• A seizure; or.
• High calcium levels--nausea, vomiting, constipation, increased thirst or urination, muscle weakness, bone pain, confusion, lack of energy, or tired feeling.

Q.Does parathyroid affect weight?

Hyperparathyroidism patients sometimes experience chronic fatigue, which makes them less active and more prone to weight gain. Conversely, if a parathyroid tumor is removed, the body is better equipped than ever before to maintain consistent calcium levels.

Q.How does high calcium make you feel?

Too much calcium can cause an upset stomach, abdominal pain, nausea, vomiting, and constipation. Bone pain and muscle weakness. Hypercalcemia can cause the bones to release too much calcium, leaving them deficient. This abnormal bone activity can lead to pain and muscle weakness.

Q.What happens when parathyroid is removed?

Only one half functioning parathyroid gland is needed for calcium control. If all four parathyroid glands were injured or removed during surgery, the blood calcium levels can become lower than normal.

Q.What should I expect after parathyroid surgery?

You should expect to return to work within 1-2 weeks. Typically recovery from surgery is short and pain is minimal. The most common complaint following surgery is fatigue, a sore throat and generalized soreness which usually resolves within a week or two.

Q.What causes too much calcium buildup in body?

Hypercalcemia is usually a result of overactive parathyroid glands. These four tiny glands are situated in the neck, near the thyroid gland. Other causes of hypercalcemia include cancer, certain other medical disorders, some medications, and taking too much of calcium and vitamin D supplements.

Q.What foods to avoid when calcium is high?

• Cut back on foods high in calcium.
• Greatly limit or stop your intake of milk, cheese, cottage cheese, yogurt, pudding, and ice cream.
• Read food labels. Don't buy dairy products with added calcium.
• Calcium-fortified orange juice.
• Calcium-fortified ready-to-eat cereals.
• Canned salmon or sardines with soft bones.