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The parathyroid glands are one of the seven endocrine glands in the body. Endocrine glands play the important role of releasing hormones into the blood. Hormones are chemical messengers that tell different parts of the body what to do and how to do it. Every endocrine gland releases its own hormones and plays a unique role in the body’s function.
The parathyroid glands are located behind the thyroid gland and release parathyroid hormone which is in charge of regulating calcium levels in the blood. The parathyroid gland also has influence over vitamin D and phosphorus levels.
Parathyroid disease is common. Typically, parathyroid disease occurs in the form of primary hyperparathyroidism. Primary hyperparathyroidism is one of the most common hormonal disorders, occurring in about 100,000 people in the United States each year.
Parathyroid Hormones
The parathyroid glands are four glands that are located behind the thyroid. Parathyroid glands release parathyroid hormones which help to regulate calcium, vitamin D and phosphorus levels. Calcium is a vital mineral that is found in the blood and bones. Many people think of calcium as being important for bone health but it also serves other functions as well.
Blood calcium levels influence some of the following functions:
- Making sure the nerves work properly
- Helping muscles contract with movement
- Helping blood clot when bleeding
- Making the heart work properly
For this reason, when calcium levels are thrown off due to a parathyroid issue, symptoms can be quite evident.
Many functions and substances all work together to help the body work properly. Two other important substances in the body that are affected by parathyroid hormones are vitamin D and phosphorus.
Vitamin D exists in the body as a hormone called calcitriol or active vitamin D. Active vitamin D helps to increase the calcium that your gut absorbs from food and releases it into the bloodstream. It also helps with retaining calcium by preventing calcium loss from the kidneys.
Parathyroid hormone helps to increase active vitamin D levels by increasing the activity of the enzyme that converts vitamin D into the active form (calcitriol). Because vitamin D affects calcium levels, parathyroid hormone affects vitamin D in an effort to further regulate calcium.
Phosphorus also affects calcium levels. Phosphorus and calcium have an inverse relationship, meaning when calcium levels rise, phosphorus levels decline and vice versa.
In summary, the parathyroid gland affects vitamin D levels as a way to further regulate calcium levels. Because calcium levels affect phosphorus levels, the parathyroid gland also affects phosphorus levels.
How Do the Parathyroid Hormones Work?
When the body detects low calcium levels, the parathyroid gland is signaled to release parathyroid hormone to help. Parathyroid hormone (PTH) helps to increase calcium levels by influencing three main parts of the body:
- Small intestine: The small intestine is where food goes to be digested. Parathyroid hormones send a signal to the small intestine, telling it to absorb more calcium from food.
- Bones: Many people know that calcium is found in the bones. Parathyroid hormones tell the bones to release small amounts of calcium into the blood.
- Kidneys: The kidneys are where vitamin D is converted to its active form. PTH enables the production of active vitamin D in the kidneys and tells the kidneys to retain calcium, rather than dispose of it through the urine.
Functions of Parathyroid Glands
Keeping precise calcium levels in the blood is essential for overall health. When low calcium is detected, the parathyroid glands are signaled to release PTH. PTH then becomes active in the body for a few minutes. Once blood calcium levels have increased to a normal level, the parathyroid glands stop releasing PTH.
Parathyroid Gland Surgery
Sometimes parathyroid glands malfunction and surgery is needed. One of the most common reasons for parathyroid surgery is a non-cancerous growth called parathyroid adenoma. These growths cause hyperparathyroidism, which is an overactive parathyroid gland. Excessive parathyroid hormone leads to calcium imbalances in the blood which can be dangerous.
Surgery for parathyroid gland disorder involves the removal of the growth. Luckily parathyroid glands can still function fully even when only part of the gland is present, this makes surgery a safe and effective treatment.
For parathyroid gland surgery, you will be placed under general anesthesia. A small incision will be made at the front of your neck and your thyroid will be lifted out of the way to expose the parathyroid glands. Your surgeon will then locate the enlarged parathyroid gland and remove it. Because the parathyroid gland is surrounded by several important structures, there are some risks of surgery including:
- Nerve injury to the laryngeal nerve which helps the voice box function properly. This uncommon complication can cause permanent change to the voice but is incredibly rare.
- Low calcium levels are usually a temporary issue following parathyroid surgery as the gland learns to function again following partial removal.
- Bleeding is always a risk of surgery. Sometimes surgical incisions bleed more than they are supposed to. You will be kept for observation for a period of time to evaluate for any abnormal bleeding.
- Mild pain is also common with any surgery. Although parathyroidectomy is typically not a very painful surgery, it is normal to experience some discomfort when swallowing or moving the neck following surgery.
You’ll want to choose the best parathyroid surgeon for a fast and effective recovery. See if your insurance will cover your surgery at UCF Health.
When is Parathyroid Gland Surgery Needed?
When the parathyroid gland is not functioning properly, uncomfortable symptoms can occur due to calcium imbalances in the blood. Sometimes parathyroid gland disorders require surgical removal of one or more of the glands. Some conditions that may warrant parathyroid gland surgery include hyperparathyroidism and hypocalcemia.
Hyperparathyroidism
Hyperparathyroidism occurs when the parathyroid gland is overactive, meaning that it secretes too much parathyroid hormone. Hyperparathyroidism can happen for several different reasons and may be considered primary or secondary.
Primary hyperparathyroidism
Primary hyperparathyroidism occurs when the cause is related directly to the parathyroid gland itself. Usually, the parathyroid gland has abnormal cell growth, causing it to release an excess amount of parathyroid hormones. More often than not, the growths that are found on the parathyroid gland are non-cancerous but in rare cases, they can be cancerous.
Primary hyperparathyroidism causes symptoms such as:
- Brittle bones
- Kidney stones
- Increased stomach acid-causing ulcers
- Pancreatitis
- Heart disease
Secondary hyperparathyroidism
Secondary hyperparathyroidism occurs when something in the body is causing the parathyroid glands to release extra hormones. The parathyroid glands are functioning normally but they are responding to a different cause. Secondary hyperparathyroidism can be caused by vitamin D deficiency or kidney failure.
Typically, both conditions can be treated with medications and surgery is not necessary. In some patients with kidney failure, medications may not work and surgery would be required to remove all four glands. Symptoms of secondary parathyroidism are the same as primary but may also include:
- Bone deformities
- Calcium deposits in fat
- Itchy skin
- Non-healing wounds
Hypocalcemia
Hypocalcemia occurs when you have low levels of calcium in the body. The cause of hypocalcemia varies but one of the most common causes is hypoparathyroidism–an underactive parathyroid gland. Hypocalcemia can also be caused by a vitamin D deficiency and kidney failure.
Symptoms of hypocalcemia include:
- Muscle cramps
- Dry skin
- Brittle nails
If you’re experiencing abnormal symptoms, it is important to see a doctor soon to determine what’s going on. The skilled specialists at UCF Health are here to help you.
Types of Surgery
There are four main types of parathyroidectomy surgery: open, minimally invasive, endoscopic and video-assisted.
Minimally Invasive Parathyroidectomy
A minimally invasive parathyroidectomy offers a shorter recovery time and lower risk than some more invasive options. Your surgeon will only have to make a small 1 or 2-inch incision and this can be done in as little as an hour.
Endoscopic or Video-Assisted Parathyroidectomy
There are a couple of different endoscopic or video-assisted approaches to parathyroidectomy. Generally, your doctor will make a few small incisions (two to three) that are smaller in size. They will insert a small camera device into one of the incisions while removing the parathyroid glands through the other incisions.
What to Expect For Parathyroid Gland Surgery
Before surgery
Before parathyroid gland removal surgery, your team will go over all of the necessary information including risks and answer any questions you have. You will be instructed to stop eating and drinking at a certain time to prepare for surgery. You may have any of the following tests prior to surgery: x-ray, physical exam, blood tests, hormone testing, CT scan or venous sampling.
During surgery
Parathyroid gland surgery requires general anesthesia. You’ll be given anesthesia through an IV or through a mask to sedate you so that you aren’t aware of the pain of surgery. Your doctor will make a small incision in your neck to remove your parathyroid gland. The exact technique they use will vary.
After surgery
Most patients are able to eat, drink and walk around normally following surgery. Minor pain, soreness in the throat and hoarseness of the voice are all common symptoms following surgery. You will be given special instructions related to calcium supplementation and you may have to have some blood tests done to look at your hormone and calcium levels.
It is important to avoid lifting anything heavy for at least one week and to allow your incision to heal before scrubbing or washing it. A follow-up appointment with your doctor will be scheduled for a week or so after surgery in which they’ll check your incision and do any follow-up testing to assess if the surgery was successful.
Conclusion
The parathyroid glands may be small but they play an important role in the body. Issues with this vital gland can be nothing short of scary. The providers at UCF Health are here to help you find answers and get to the root of your symptoms. Discover how we can help you today.