What are parathyroid glands
Parathyroid glands are small, pea-sized glands of the endocrine system located behind the thyroid gland.  There are four parathyroid glands which serve to regulate the calcium level in our bodies.  In response to a low blood calcium level, the glands produce parathyroid hormone (PTH) which serves to raise the blood calcium level. 

Hyperparathyroidism is a disorder in which too much parathyroid hormone (PTH) is secreted from the parathyroid glands, resulting in abnormally high levels of calcium in the blood (hypercalcemia). Hyperparathyroidism is further classified as being primary, secondary, and tertiary.  Primary hyperparathyroidism is more common than either secondary or tertiary hyperparathyroidism, which occurs in patients with kidney failure or a severe vitamin D deficient state.

Causes
In most cases of hyperparathyroidism, the exact cause is not known.  
Factors that may contribute to hyperparathyroidism include the following:

An adenoma (benign tumor) in the parathyroid gland (accounting for 85% of primary hyperparathyroidism)
Hyperplasia (enlargement) of the parathyroid glands (accounting for over 80% of secondary or tertiary hyperparathyroidism)
Parathyroid cancer (Less than 1%)
Familial hyperparathyroidism
Vitamin D deficiency (due to malabsorption, lack of sunlight exposure, inadequate dietary intake)
Radiation therapy to head or neck during childhood
Multiple endocrine neoplasia (MEN)
Kidney failure or other medical problems that make the body resistant to the action of the parathyroid hormone (called secondary hyperparathyroidism)

Symptoms
Up to 80% of patients with HPT have no obvious symptoms, but are similar to other common conditions such as menopause, mid-life crisis, stress, depression, and even early dementia.  The degree of hypercalcemia, as well as how rapidly the disease progresses, will determine both the type and severity of the symptoms. Symptoms commonly seen with primary hyperparathyroidism include the following:

• Loss of appetite
• Thirst
• Frequent and sometimes painful urination
• Lethargy
• Fatigue
• Muscle weakness
• Joint pain
• Constipation
• Nausea
• Vomiting
• Abdominal pain
• Memory loss
• Depression
• Weight loss
• Back pain

Diagnosis

• Blood Tests – Measures calcium, phosphorus, alkaline phosphatase, vitamin D, and/or PTH
• Urine Test – Measures calcium excretion and kidney function
• Abdominal X-ray – This test can show kidney stones caused by high calcium levels
• Bone Density Test – Measures bone loss and risk of fractures
• Neck Ultrasound – This test can help detect a large parathyroid tumor (adenoma).
• Sestamibi Scan - This test involves a radioactive agent called “technetium sestamibi” given intravenously.

A sestamibi scan is usually done along with an ultrasound study, but both tests may fail to identify a parathyroid adenoma in 10 to 20% of patients. Therefore, other tests sometimes need to be done. Additional tests may include MRI, CT scan, or venous sampling if necessary.

Surgical Guidelines
The best candidates for HPT surgery have:

• Symptoms of HPT
• Kidney stones
• Evidence of bone disease
• Severe hypercalcemia

If no symptoms are present, surgery can also be indicated for patients with:

• A calcium level in the blood that is more than 1 mg/dL above the normal level
• A calcium level in urine that is more than 400 mg/day
• Significant kidney dysfunction (reduction in creatinine clearance of 30% or more)
• Osteoporosis

Treatment
We offer minimally invasive parathyroidectomy using intraoperative PTH monitoring.

Advantages over traditional parathyroidectomy:

• Smaller incision and therefore smaller scar
• Usually a same day procedure
• No risk to nerves and other structures on the “normal” side of the neck
• Less pain
• Faster return to normal activities