The human body boasts many complex systems and organs, each serving its distinct purpose. Among them are the parathyroid glands—tiny yet mighty.
Though often overshadowed by their close neighbour, the thyroid gland, the parathyroid plays a pivotal role in our body’s calcium regulation. Let’s delve into the intricacies of parathyroid disorders and their implication with Dr Jeeve Kanagalingam, Senior Consultant at The ENT Clinic.
Understanding the Parathyroid Glands
Dr Jeeve: The parathyroid glands are four tiny glands close to the thyroid gland that are the size of a grain of rice. They produce parathyroid hormone, essential in keeping calcium levels in your blood and body regular. Parathyroid hormone (PTH) causes the release of calcium from the bones, encourages calcium resorption from urine in the kidneys, and converts vitamin D to an active form that helps the intestine absorb calcium. The sum effect is to increase the calcium level in the blood.
Symptoms and Diagnosis
Dr Jeeve: The most common problem with parathyroid glands is overactivity (or hyperparathyroidism). This leads to an increase in PTH and, subsequently, an increase in the calcium level in your blood. These may cause subtle symptoms such as a loss of appetite, tiredness, muscle weakness, nausea, and more severe symptoms such as confusion and disorientation.”
High calcium levels can also lead to kidney stones and abdominal pain due to ulcers or pancreatitis. The loss of calcium from bones will eventually lead to osteoporosis (softening of the bones) and potentially fractures.
medical students are often taught the symptoms of hyperparathyroidism by recalling the phrase Stones, bones, abdominal groans and psychic moans”! It helps clinicians think of hyperparathyroidism when seeing patients with a constellation of wide-ranging symptoms and signs.
Differences between hyperparathyroidism and hypoparathyroidism
Dr Jeeve: Hyperparathyroidism is most often due to overactive parathyroid glands. A single overactive parathyroid gland is called a parathyroid adenoma. If all glands are active, this is called parathyroid hyperplasia. As the leading cause of a high PTH level is the gland, the condition is often termed primary hyperparathyroidism. Secondary or Tertiary hyperparathyroidism is due to vitamin D deficiency or problems with the kidneys
Hypoparathyroidism is usually seen in patients who have had neck surgery or radiation treatment to the neck. Rarely autoimmune conditions and a low magnesium level can lead to underactive parathyroid glands.
The symptoms of hypoparathyroidism are tingling in the fingers and toes, facial twitching and cramps.
Dr Jeeve: Treatment of parathyroid disorders largely depends on the cause. In primary hyperparathyroidism, where there is an enlarged and overactive parathyroid gland (i.e. an adenoma), surgery to remove the adenoma is highly effective. For patients who cannot have surgery, a drug called Cinacalcet is often used. In secondary hyperparathyroidism, correcting the underlying problems (e.g. vitamin D supplementation) is essential. In hypoparathyroidism, we use an activated form of vitamin D, known as Calcitriol, to maintain blood calcium levels.
Long Term Implications
Dr Jeeve: Maintaining normal calcium levels ensures good bone strength. Softening of the bones (osteoporosis) increases the risks of hip and spine fractures. Similarly, high calcium levels also predispose to kidney stones. As the symptoms of hyperparathyroidism can be subtle, it is worth checking and monitoring blood calcium levels, especially in the elderly.