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Bardají Bofill Manel

Cirugía General Adultos

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Parathyroid

Parathyroid surgery

The parathyroid glands are the small glands of the endocrine system that are located behind the thyroid.

There are usually four parathyroid glands that are normally about the size of a pea. They are shown in this chart as the mustard yellow glands behind the pink thyroid gland. This is its normal color.

The sole purpose of the parathyroid glands is to secrete the hormone parathormone (PTH) which is responsible for regulating the level of calcium in our bodies within a very narrow range so that the nervous and muscular systems can function properly and the metabolism of calcium and phosphorus.

Although they are neighbors and part of the endocrine system, the thyroid and parathyroid glands are otherwise unrelated.

The main disease of the parathyroid glands is the overactivity of one or more of the parathyroids that produce too much parathyroid hormone that causes a potentially serious calcium imbalance. This is called hyperparathyroidism.

The most common cause of excess hormone production is the development of a benign tumor in one of the parathyroid glands. This exaggerated or increased growth of a parathyroid gland is called a parathyroid adenoma which makes up 87-93 percent of all patients with primary hyperparathyroidism.

This situation is illustrated here: one of the parathyroid glands has developed a tumor that is secreting all the hormone... that the other three glands are small and respond appropriately to high calcium becoming inactive (the parathyroids are yellow and are located behind the larger lobes of the thyroid demonstrated in light pink).

It is essentially never cancerous (less than one in 500), yet it slowly causes damage to the body because it induces an abnormally high level of calcium in the blood that can slowly destroy a number of tissues. Parathyroid adenomas are typically much larger than normal classified parathyroids (demonstrated on the scale).

Approximately 7 to 11 percent of all patients with primary hyperparathyroidism will have an enlargement of all four parathyroid glands, a term called parathyroid hyperplasia.

In this case, all the parathyroid glands enlarge and produce too much parathyroid hormone. This is a much less common scenario but the final results in the tissues of the body are identical.

An even rarer situation occurs in about 3% of people who have two parathyroid adenomas while having two normal glands. This is a very rare situation and can make the diagnosis and treatment of this disease relatively difficult.

In short:

87% a single adenoma or a single hyperfunctioning parathyroid gland
9% hyperplasia of all four glands or overfunctioning of all 4 glands
3% multiple adenomas - 2 or 3 hyperfunctioning adenomas
< 1% = parathyroid cancer (very rare!!)

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Symptoms of hyperparathyroidism
In this condition, the glands secrete too much PTH and blood calcium levels become too high and place the patient at risk for developing kidney stones, bone fractures, pancreatitis, hypertension and gout.

Other symptoms include muscle pain and weakness, constipation, depression, anxiety, loss of appetite, increased and exaggerated thirst, weight loss, lethargy, and rarely, a palpable neck mass.

Most of these patients will actually say that they feel better after the problem has been cured. Many patients who thought they were asymptomatic preoperatively sleep better at night, be less irritable, and find that they remember things much more easily than when their calcium levels were high (nervous system problems).

Patients with persistently elevated calcium levels due to overproduction of parathyroid hormone may also have complaints of bone pain. (osteoporosis osteopenia).

This problem is more aggravated in older patients. Bones may also have small bleeds within their center that cause bone pain.

Other symptoms are the development of gastric ulcers and pancreatitis. High levels of calcium in the blood can be dangerous to a number of cells including the stomach and pancreas that become inflamed and painful (ulcers and acute pancreatitis). Another common presentation for persistently elevated calcium levels is the development of kidney stones. Since the main function of the kidney is to filter and clean the blood, they will be constantly exposed to high levels of calcium in patients with hyperparathyroidism. The constant filtering of large amounts of calcium will cause the collection of calcium within the renal tubules leading to kidney stones. In extreme cases the entire kidney can calcify and even acquire bone characteristics due to the deposition of both calcium within the tissues. Not only is this painful due to the presence of kidney stones, in severe cases it can cause irreversible kidney lesions.
Potential Dangers of Hyperparathyroidism
Peligros potenciales del hiperparatiroidismo
- Severe osteoporosis and osteopenia.one fractures.
- Kidney stones.
- Peptic ulcers.
- Pancreatitis.
The incidence of these problems depends mainly on the duration of the disease and its severity. Everyone will lose bone density, which is progressive.

Pancreatitis and ulcers are much rarer. Most of the demand from patients who feel "barely fine" when this disease is diagnosed, all 80 percent of them demand to feel (better sleep, etc.) three months better after the problem has been fixed.

Don't choose to experience surgery (or decide not to do so) based on how you feel. Remember, the typical patient has had this disease for several years before it was always found, because it does its bad things so quietly.

The good news is that they can be cured with an overall functioning that results in a success rate of about 95% and a complication rate of about 1% or less.

The parathyroid glands are located immediately behind the thyroid gland. Most people have four parathyroid glands (about 5% of the population has a fifth gland).

These glands regulate the level of calcium in the blood by producing a hormone called PTH (parathyroid hormone) that stimulates the release of calcium from the bones and the absorption of calcium by the kidney. The most common indication for surgery of the parathyroid glands is primary hyperparathiroidism.

Treatment is surgical. The adenomas are removed and all abnormally enlarged parathyroid glands are biopsied. Hyperplasia affects all four parathyroid glands and usually requires surgical excision.

Some parathyroid tissue is preserved and reimplanted where it will continue to produce PTH and regulate blood calcium levels. Carcinoma of the parathyroid glands requires removal of the affected gland and adjacent nodes involved. Possible postoperative complications of parathyroid surgery include injury to the laryngeal and recurrent nerves with resulting aphonia/dysphonia.

Injury to the parathyroid glands can also result in low blood calcium which always requires calcium replacement.

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Centro Médico Teknon

Bardají Bofill Manel

Consultorios Marquesa (despacho 34)

Marquesa de Vilallonga, 12

08017 Barcelona

93 290 64 34 / 93 417 23 02 (Fax)

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Carrer de Vilana, 12, 08022 Barcelona

932 906 200 / 900 301 013