Parathyroid glands:
The parathyroid glands are small glands that lie next to the thyroid gland in the lower part of the neck. There are four parathyroid glands two on each side, each one is about the size of a piece of rice. They make parathyroid hormone (PTH) which controls the level of calcium in the blood.
Calcium:
The human body contains 1 kg of calcium. Most (99%) of this is stored in the bones. There is some calcium in the blood. Parathyroid hormone controls the level of calcium in the blood by:
Controlling the flow of calcium between the bones and the blood
Increasing the absorption of calcium from the intestines
Increasing the resorption of calcium from the kidneys.
Hyperparathyroidism:
Hyperparathyroidism occurs when there is too much parathyroid hormone. Patients with hyperparathyroidism may have no symptoms. More commonly patients feel tired, lack energy and have various aches and pains. Sometimes patients have one or more of the following: kidney stones, osteoporosis, fractures of bones, constipation, stomach ulcers, pancreatitis and depression. Over time the high parathyroid hormone level leaches calcium out of the bones resulting in osteoporosis and making the bones susceptible to fractures.
Hyperparathyroidism is diagnosed with a blood test. The calcium level is normal or high. The parathyroid hormone level is high.
There are two main types of hyperparathyroidism. Primary hyperparathyroidism occurs when one or more parathyroid glands is enlarged and makes too much parathyroid hormone. Secondary hyperparathyroidism occurs in response to calcium deficiency, vitamin D deficiency or chronic kidney failure.
Treatment of hyperparathyroidism:
Most patients with primary hyperparathyroidism should be considered for surgery. Patients with secondary hyperparathyroidism due to a vitamin D deficiency required vitamin D supplements.
Parathyroidectomy:
Parathyroidectomy is the name given to the operation where one or more parathyroid glands are removed. Often two scans are requested to locate the abnormal parathyroid gland making too much parathyroid hormone. These scans are an ultrasound scan and a sestamibi scan. Parathyroidectomy is done under general anaesthesia (you are fast asleep), you spend one night in hospital and are off work for one week. A small incision is made in a skin crease in the lower part of the neck. The operation is usually highly successful. Occasionally (2%) the operation is not successful and the condition is not cured. Other potential complications include a low calcium level and injury to the recurrent laryngeal nerve resulting in hoarseness.
Dr Hall and parathyroidectomy:
Dr Hall has a lot of experience with parathyroidectomy, both primary hyperparathyroidism and tertiary yperparathyroidism. He has successfully performed revision hyperparathyroidism. He presented his results on parathyroidectomy at the New Zealand Society of Otolaryngology Head and Neck Surgery annual scientific meeting in Queenstown in 2007. The majority of patients in his hands undergo a localised approach through a small incision.