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Parathyroid Disorders

Although their names are similar and they share a biological address, your parathyroid glands serve a completely different purpose than your thyroid gland. The parathyroid glands, four pea-sized structures around the thyroid, produce a hormone called PTH (parathyroid hormone), which regulates your body’s levels of calcium and phosphorus in the blood, nervous system, and bones.

If your body makes too much PTH, you have hyperparathyroidism and your blood calcium levels will be too high. If you make too little PTH, you have hypoparathyroidism characterized by low levels of calciumand too much phosphorus in your blood. Of the two conditions, hyperparathyroidism is by far the most common. Both of these are parathyroid disorders.

Hyperparathyroidism

Nearly 95% of patients with hyperparathyroidism will have some symptoms of the condition. But higher calcium levels do not necessarily correlate with more symptoms or more severe symptoms. In other words, even mildly elevated calcium levels can indicate hyperparathyroidism and cause very serious problems. Left untreated, patients with hyperparathyroidism are prone to potentially deadly heart attacks and strokes. It’s therefore critical that even “mild” cases of hyperparathyroidism be treated by a qualified specialist.

Other symptoms include:

  • Kidney stones
  • High blood pressure
  • Frequent headaches (especially in patients under age 40)
  • Depression
  • Osteoporosis or osteopenia
  • Bone pain
  • Difficulty sleeping
  • Irritability
  • Thinning hair (in female patients)
  • Loss of libido
  • Acid reflux, heartburn
  • Heart palpitations
  • Abdominal cramps

Diagnosing hyperparathyroidism is very straightforward. If you’re experiencing symptoms, blood tests to measure the amount of PTH and calcium can confirm the presence of the condition. If both PTH and calcium levels are high, it’s a certainty that you have hyperparathyroidism. However, even if only the calcium is high but PTH is normal, you still may have hyperparathyroidism and you should discuss it with your physician.

The cause of primary hyperparathyroidism is almost always a benign tumor, for which surgical removal is the treatment of choice. Hyperparathyroidism can also be the result of kidney failure.  It can sometimes occur with a constellation of other endocrinologic problems.  By removing an a parathyroid gland with a tumor and leaving the healthy glands in place, your symptoms will disappear and your calcium levels will return to normal. Your remaining parathyroid glands will take over the function of the missing one. You don’t actually need all four, even just one will do fine.

Hypoparathyroidism

Hypoparathyroidism is a very rare condition marked by inadequate parathyroid hormone production.  It is almost always caused by damage to or, more likely, surgical removal of all four parathyroid glands. If a patient had prior parathyroid or thyroid surgery, hypoparathyroidism may well be a surgical complication.

Low levels of PTH results in low blood levels of calcium and heightened levels of blood phosphorus. Because calcium regulates the activity of the nervous system, the symptoms of low calcium are muscle cramps, tingling sensations in the hands and mouth, and occasionally, convulsions. If left untreated, hypoparathyroidism can result in kidney failure.

There is no bioidentical replacement for PTH. The closest thing is a drug called Forteo that the pharmaceutical company Lilly made to treat osteoporosis in post-menopausal women. Although not FDA-approved for the treatment of hypoparathyroidism, some doctors do prescribe it for this use. It is given as a self-administered daily or twice-daily injection.

Because Forteo doesn’t work for everyone with hypoparathyroidism and there are safety concerns with the drug, most treatment for hypoparathyroidism is focused on raising calcium levels. Calcium and Vitamin D supplements, sometimes in very high doses, are required to bring blood calcium levels back into a normal range.

As an otolaryngologist specializing in care of the ears, nose, throat, head and neck, Dr. Yagoda can determine whether you have a parathyroid disorder, and if so, can recommend the best options for treatment.