There are 4 parathyroid glands located in your neck behind your thyroid gland. There is one located at the top of each thyroid lobe and one at the bottom of each thyroid lobe. Each one of these 4 glands is about the size of a grain of rice. The main function of the parathyroid gland is to secrete parathyroid hormone (PTH) which regulates the level of calcium in your blood.
When you have hyperparathyroidism one or more of your parathyroid glands are producing too much parathyroid hormone. This is usually due to an abnormal enlargement of one of the parathyroid glands called an adenoma. Thankfully these are almost always benign. In rare cases, you may have parathyroid hyperplasia, which is when all four parathyroid glands are enlarged and are producing increased amounts of PTH.
Primary hyperparathyroidism causes a rise in your serum calcium level called hypercalcemia. Symptoms of high serum calcium include kidney stones, joint and bone pain, abdominal pain, constipation, muscle pain, fatigue and decreased ability to concentrate. If left untreated hypercalcemia can cause pathologic fractures and osteoporosis. If you have a history of hypercalcemia, your doctor may recommend a bone density study to determine how healthy your bones are.
To help diagnose primary hyperparathyroidism your primary care physician or endocrinologist will order blood tests to check your PTH level and calcium level. If both of these come back elevated, your primary or endocrinologist can run several other tests to rule out other causes of high PTH levels and hypercalcemia such as low vitamin D levels or kidney disease. In order to help determine if you have an adenoma and its location, imaging can be ordered. This may include a sestamibi scan, ultrasound of the neck or a CT scan.
The most common treatment for a parathyroid adenoma is surgery. If surgery is recommended, this is completed in the operating room under general anesthesia. In most cases, this can be accomplished through a small incision, about one inch, in the neck. To determine the successful identification of the adenoma, a rapid parathyroid hormone blood test will be done during the operation. This will show a rapid decrease in parathyroid hormone once the adenoma has been removed. After the surgery, you may have a little swelling over the incision with a minor feeling of fullness. This usually lasts for 2-3 days. Afterward, you may be required to take calcium supplements to help replenish the calcium in your bones.