Sinus, Allergy & Asthma Center
Head & Neck Surgical Oncology Center
Thyroid Surgical Institute
Speech, Voice & Swallowing Center
Hearing & Balance Center
Facial Plastic & Reconstructive Surgery Center
Facial Nerve Disorders
Sleep Disorders
Could your Fatigue be a
parathyroid disorder?
Learning about the Parathyroid
Most people have four parathyroid glands,
one located on each of the corners of another
gland, the thyroid, which is located in the lower
neck, partially surrounding the windpipe like a
horseshoe. In spite of the similarity in name and
location, the parathyroid glands and thyroid
gland are separate glands with very different
functions.
The parathyroid glands, unlike the thyroid which
regulates metabolism, produce a hormone
that helps maintain the proper balance of
calcium and phosphorus in your body. In
hyperparathyroidism, your parathyroid glands
produce too much parathyroid hormone. Most
often, there is an accompanying elevation
of calcium in the bloodstream. The resulting
imbalance in calcium and phosphorus can create
a multitude of health problems — including
affecting your teeth, bones, nervous system and
muscles.
Treatment depends on several factors, including
which type of hyperparathyroidism you have.
Our Mission
FTo provide the best care for our patients in a compassionate and
caring environment.
FTo work to advance the art, science and ethical practice of Otolaryngology,
Head & Neck Surgery.
FTo provide the most contemporary medical and surgical approaches to
treating disorders of the ears, nose, throat and related structures of the head and neck.
FTo integrate our efforts with those
of primary care physicians and other specialists to optimize patient
outcomes.
FALL 2009 • Issue Ten
ENTA Allergy, Head & Neck Institute
101 W. McKinley Ave. • Decatur, IL 62526 • 217.876.ENTA (3682) • 217.876.3345 FAX
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SYMPTOMS OF
Hyperparathyroidism
The majority of people with hyperparathyroidism have no signs or symptoms. The elevated Calcium is detected on routine blood
testing. In those who do, the symptoms frequently come on slowly and are usually subtle, such as a feeling of weakness or fatigue,
or vague aches and pains. But more severe signs and symptoms can develop over time. These include: increased thirst and urination,
kidney stones, heartburn, abdominal pain, nausea, vomiting, thinning bones, confusion, and poor memory.
Having too much parathyroid hormone can lead to several serious problems including:
• Osteoporosis. Hyperparathyroidism poses a long-term threat to your bones — the more parathyroid hormone your parathyroid
glands produce, the more calcium your bones lose. The result is weak, brittle bones that are prone to fractures.
• Kidney damage or kidney stones. Because your body tries to compensate for excess calcium by excreting more of the mineral in your
urine, you’re at increased risk of kidney damage or kidney stones.
• Peptic ulcers. High blood levels of calcium stimulate your stomach to produce more acid, making you more likely to develop peptic
• High blood pressure. High calcium levels can put you at increased risk of high blood pressure (hypertension) and congestive heart failure
Why Calcium is Important
Calcium is the most abundant mineral in your body, best known for its role in keeping your
teeth and bones healthy. But calcium also helps your blood clot, aids in the transmission of
signals in nerve cells and is involved in muscle contraction. Phosphorus, another mineral, works in
conjunction with calcium in these areas.
The parathyroid glands maintain proper levels of both calcium and phosphorus in
your body by turning the secretion of parathyroid hormone (PTH) off or on, much
as a thermostat controls a heating system to maintain a constant air temperature.
Vitamin D also is involved in regulating the amount of calcium in your blood, and its
actions work in tandem with parathyroid hormone.
Normally, this balancing act works well. When calcium levels in your blood fall too
low, your parathyroid glands secrete enough PTH (parathyroid hormone) to raise
the calcium. This occurs because PTH raises calcium levels by releasing calcium from
your bones and increasing the amount of calcium absorbed from your small intestine.
When blood calcium levels are too high, the parathyroid glands normally produce less
PTH. But sometimes one or more of these glands produce too much hormone, leading
to abnormally high levels of calcium (hypercalcemia).
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Primary Hyperparathyroidism
The most common form of hyperparathyroidism is primary
hyperparathyroidism. This type is caused by a benign growth
(adenoma) on one of the four parathyroid glands, although
this disorder can also occur when two or more glands become
enlarged (hyperplasia) and produce too much hormone.
Hyperparathyroidism may also be caused by cancer of one of the
parathyroid glands (very rare).
Diagnosis of Primary Hyperparathyroidism
The diagnosis of primary hyperparathyroidism is made by
noting elevation of serum calcium along with an elevation of
the intact PTH (parathyroid hormone) level. While there are
occasionally other conditions which can share this abnormality,
it is almost always due to primary hyperparathyroidism. Other
tests which can assist the physician include measurements
of serum ionized calcium, Vitamin D levels (25-hydroxy and
1,25 hydroxy-cholecalciferol), phosphorus, and kidney function
tests. Measurement of urinary calcium (24 hour collection) and
bone densitometry may also be requested. Localizing imaging
tests include the Cardiolyte (Technetium Sestamibi) scan and
ultrasonography. Ultrasonography can also identify associated
pathology i.e. nodules, masses or tumors, within the thyroid
gland which might necessitate evaluation before surgery for the
parathyroid problem is recommended.
There are subgroups of patients who have a familial or
hereditary variant of primary hyperparathyroidism. Some are
found in association with so called MEN or Multiple Endocrine
Neoplasia syndromes in which patients have tumors or other
endocrine organs. The diagnosis and approach to these
subgroups is considerably different than sporadic typical primary
hyperparathyroidism.
Treatment of Primary Hyperparathyroidism
Surgery is the mainstay of treatment of primary
hyperparathyroidism. The goal is to remove the “tumor” or
adenoma which causes the condition in most patients. In the 10
– 15% of patients who have Hyperplasia or multiple Adenomas,
exploration and removal of all offending glands is necessary.
The last several years has seen a major change in the surgical
approaches to the disease focusing on more minimally invasive
outpatient approaches. This requires surgical experience and
expertise.
Traditionally, the surgery involved a long incision, exploration
on both sides of the neck and general anesthesia. While there is
nothing wrong with this approach, more contemporary techniques
such as minimally invasive radioguided parathyroidectomy,
The diagnosis of primary
hyperparathyroidism is made by noting elevation of serum
calcium along with an elevation
of the intact PTH (parathyroid
hormone) level.
may be preferred for selected patients. In this procedure, we use a
radioisotope scan (Cardiolyte or Sestamibi scan) to help locate a tumor
or abnormal parathyroid gland before surgery. For the scan, you’re
given a very small dose of a radioactive material that’s absorbed
more selectively by the overactive parathyroid gland — in deference
to the healthy ones. A Nuclear Camera images the neck and
identifies the abnormal parathyroid gland. Using similar technology
transferred to the Operating room, the surgeon uses the sestamibi
scan along with a radioguiding probe to locate the abnormal gland.
The probe detects radioactivity, much as a Geiger counter does,
and assists in identification of the parathyroid tumor using a smaller
incision. Thus, unlike the surgery of yesteryear, a directed or focused
parathyroidectomy can be done in many patients whose scan
identifies the tumor before surgical exploration.
Sestamibi scanning is not the only way to identify abnormal
parathyroid glands and tumors. Ultrasound done by the surgeon in
his office or in the radiology suite can identify a parathyroid tumor
in many patients. Like the scan, this can anatomically localize the
parathyroid growth and allow the surgeon to perform a more
minimally invasive approach than might otherwise be necessary.
Ultrasound and Sestamibi scans are often both used and enhance the
confidence of localization of the abnormal parathyroid tumor.
Another technique used by surgeons to verify that a directed, or
focused, minimally invasive parathyroidectomy has been complete
CONTINUED ON NEXT PAGE
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101 W. McKinley Ave.
Decatur, IL 62526
217.876.ENTA (3682)
217.876.3345 Fax
Our Physicians
involves so called ‘quick PTH assay’ which is done
intraoperatively. Since parathyroid hormone (PTH) is
rapidly metabolized, its measurement 10 minutes after
the surgeon removes the abnormal gland or tumor
can be used to physiologically verify that no other
abnormal parathyroid tissue has been left behind.
While not always necessary, this measurement can
enhance the confidence of the surgeon in achieving
success when performing an operation in which all 4
parathyroid glands are not identified.
A parathyroidectomy can be performed through a
small incision when the tumor is clearly identified
ahead of time. However, it must be emphasized that
the length of the incision is less important than the
skill of the surgeon. Most scars are barely noticeable
within a month of surgery regardless of length. The
operation usually takes less than an hour and can
be done either under local or general anesthesia.
When local anesthesia is used, the anesthesiologist
may inject some of the regional nerves prior to the
surgery (regional block), and the patient is given some
sedation. Regardless of which type of anesthesia
is given, most patients can go home within a few
hours of the surgery. Pain is often nominal, and easily
controlled with minimal oral pain medication.
While parathyroid surgery is rarely complicated, factors
such as prior surgery in the area, morbid obesity, and
bleeding tendencies can pose hazards. Like all surgery,
there are some risks which can be kept to a minimum
in experienced hands.
At ENTA Head, Neck and Thyroid Surgery Institute, we
offer all contemporary approaches to the diagnosis
and management of Parathyroid Disorders. Extensive
experience with large numbers of patients has afforded
us perspective on which techniques are best suited
to individual patients. Considerable counseling and
patient education is provided so that patients can make
informed decisions about how they would like to be
treated for their parathyroid disorder.
Steven Sobol, MD, FACS
Medical Director
Stephen Chadwick, MD, FACS
Research Director
Terence Woods, MD, FACS
Otolaryngologist
Bethany Gibson, MD
Allergist & Immunologist
Candace N. Benner, APRN, NP
Nurse Practitioner
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