Parathyroid Conditions

The parathyroid glands are small structures located behind the thyroid gland and play a critical role in calcium regulation. Disorders of the parathyroid glands can lead to significant metabolic imbalances.

Below is an overview of common parathyroid conditions, their causes, symptoms, risk factors, and treatment options.

Overview

Primary hyperparathyroidism occurs when one or more of the parathyroid glands produce excessive parathyroid hormone (PTH), leading to elevated blood calcium levels (hypercalcaemia). It is the most common cause of hypercalcaemia in adults.

Causes

  • Parathyroid adenoma – A benign tumour in one of the parathyroid glands (most common cause)
  • Parathyroid hyperplasia – Enlargement of multiple parathyroid glands
  • Genetic syndromes – Such as multiple endocrine neoplasia (MEN) types 1 and 2A

Symptoms

  • Fatigue and weakness
  • Recurrent kidney stones
  • Osteopenia, osteoporosis, bone pain and fractures
  • Frequent urination and excessive thirst
  • Abdominal pain, nausea, and constipation
  • Depression, memory issues, and confusion

Risk Factors

  • Female gender (more common in postmenopausal women)
  • Radiation exposure to the head and neck
  • Family history of parathyroid disease
  • Genetic disorders such as MEN

Treatment Options

  • Surgery – The definitive treatment, involving removal of the overactive gland(s)
    • Minimally invasive parathyroidectomy
    • 4 gland parathyroid exploration
  • Monitoring – For mild cases with stable calcium levels and no significant symptoms
  • Medications – Such as bisphosphonates or calcimimetics to manage calcium levels in select cases

Overview

Secondary hyperparathyroidism occurs when the parathyroid glands become overactive in response to low calcium levels, usually due to chronic kidney disease (CKD). Tertiary hyperparathyroidism develops when secondary hyperparathyroidism persists despite treatment, leading to autonomous (unregulated) PTH secretion.

Causes

  • Secondary Hyperparathyroidism:
    • Chronic kidney disease (CKD)
    • Vitamin D deficiency
    • Malabsorption conditions (e.g., coeliac disease, Crohn’s disease)
  • Tertiary Hyperparathyroidism:
    • Long-standing secondary hyperparathyroidism that leads to gland enlargement and autonomous PTH secretion

Symptoms

  • Bone pain and fractures (renal osteodystrophy)
  • Joint pain and stiffness
  • Itchy skin (pruritus)
  • Muscle weakness
  • Cardiovascular complications (due to calcium deposits in blood vessels)

Risk Factors

  • Chronic kidney disease (CKD) – Most common cause in Australia
  • Long-term vitamin D deficiency
  • Intestinal malabsorption disorders
  • Dialysis dependency

Treatment Options

This involved management in conjunction with kidney specialists.

  • Vitamin D and Calcium Supplements – To correct deficiencies
  • Phosphate Binders – To control phosphate levels in CKD
  • Calcimimetics (Cinacalcet) – To reduce PTH production
  • Parathyroidectomy – Recommended in severe or resistant cases

Overview

Parathyroid carcinoma is a rare but aggressive cancer that originates in the parathyroid glands. It accounts for less than 1% of cases of primary hyperparathyroidism but can lead to severe hypercalcaemia.

Causes

  • Exact cause is unknown, but genetic mutations may play a role
  • Associated with hyperparathyroidism-jaw tumour syndrome (HPT-JT)

Symptoms

  • Severe hypercalcaemia symptoms (fatigue, confusion, excessive thirst, and urination)
  • Neck mass or lump
  • Hoarseness or voice changes (if the tumour affects nearby structures)
  • Bone pain and fractures
  • Kidney stones

Risk Factors

  • Family history of parathyroid carcinoma or HPT-JT syndrome
  • Previous radiation exposure
  • Long-standing untreated primary hyperparathyroidism

Treatment Options

  • Surgery (En Bloc Resection) – Complete removal of the cancerous gland and surrounding tissues
  • Medical Management – Including bisphosphonates or calcimimetics to control hypercalcaemia
  • Radiotherapy or Chemotherapy – Limited effectiveness but may be used in advanced cases

Conclusion

Dr Laura Wang specialises in the diagnosis and treatment of parathyroid disorders with a patient-centred approach. If you have concerns about parathyroid conditions, a thorough evaluation and personalised treatment plan can help restore calcium balance and overall well-being. Book a consultation today for expert care tailored to your needs.

Dr Laura Wang is a highly-experienced, fellowship-trained Endocrine and Head & Neck surgeon consulting and operating across Sydney.

Dr Wang holds both a Master of Surgery (MS) Degree and a Doctorate of Philosophy (PhD) in thyroid cancer surgery and performs a high-volume of thyroid and parathyroid surgeries. She was the first surgeon to be dual-trained in both head and neck cancer surgery (for benign and cancerous conditions), as well as microvascular reconstructive surgery at Memorial Sloan Kettering Cancer Centre in New York, which is the oldest cancer hospital in the world (founded in 1884).

Get in touch to book an appointment. Urgent appointments available for cancer patients.

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