Parathyroid disorders disrupt the balance of calcium in the blood, which can lead to a number of conditions. Treatment for parathyroid disorders is aimed at correcting this imbalance.

The options for treating parathyroid disorders include surgical procedures and medications. The appropriate treatment will depend on whether the patient has overactive or underactive parathyroid glands, as well as if the disorder is causing symptoms.

The four parathyroid glands, located in the throat, are responsible for regulating the amount of calcium in the blood. Patients with hyperparathyroidism produce too much parathyroid hormone, which weakens bones by removing calcium and contributes to kidney stones. Hypoparathyroidism means there is not enough calcium in the blood for nerve cells and muscles to function normally. As a result, patients may experience tingling sensations in the extremities, prolonged muscle spasms and a loss of consciousness.

Hyperparathyroidism is the most common parathyroid disorder and can be treated with a parathyroidectomy. This is the surgical removal of one or more parathyroid glands. If the surgeon can identify which gland is overactive prior to the procedure, a minimally invasive procedure may be all that is necessary. If multiple parathyroid glands must be inspected or removed, the surgery requires a larger incision.

Parathyroidectomies are highly successful treatments for hyperparathyroidism. More than 95 percent of patients are cured after the procedure, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). However, some patients may have hyperparathyroidism with no symptoms and choose to forgo treatment until symptoms appear or monitoring tests show the disorder is progressing.

Parathyroid treatments are for disorders that affect the body’s ability to regulate the amount of calcium in the blood. Hyperparathyroidism, the most common parathyroid disorder, may be treated in various ways, including a parathyroidectomy. This is the surgical removal of one or more of the parathyroid glands. Hypoparathyroidism, a rare disorder, may be treated with medications that aim to restore levels of calcium in the bloodstream.

The parathyroids are four endocrine glands, typically located on the thyroid gland in the throat, that are about the size of a pinhead. They can also be located in other places within the body and sometimes can be difficult to find. They produce and secrete parathyroid hormone (PTH), which causes bones to release calcium. PTH also stimulates the intestines and kidneys to absorb more of the mineral. As a result, the amount of calcium in the bloodstream increases.

When the parathyroid glands are overactive, they produce excess PTH and cause hyperparathyroidism. As a result of the extra calcium that is released and absorbed, patients may have kidney damage, bone deformation and fatigue, as well as various other symptoms. In most cases, hyperparathyroidism results from benign (noncancerous) growths on the parathyroid glands. In rare cases, these growths may be cancerous (parathyroid cancer).

Hypoparathyroidism is less common and occurs when the parathyroid glands do not produce enough PTH. As a result, there is not enough calcium in the blood for the body’s needs. The lack of calcium can lead to tingling sensations in the lips, fingers and toes, painful muscle spasms (tetany) and a loss of consciousness.  

The most effective treatment for hyperparathyroidism is a parathyroidectomy. During this surgical procedure, one or more overactive parathyroid glands are removed. This surgery successfully cures up to 95 percent of cases of hyperparathyroidism, according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).

After a parathyroidectomy, most patients experience normal levels of parathyroid hormone (PTH) production and are able to maintain normal levels of calcium in the blood. As a result, the symptoms of hyperparathyroidism pass and the patient no longer experiences fatigue, bone damage and kidney disease due to the disorder. Patients  can also experience increases in bone density, improved muscle strength, as well as a reduced risk of kidney stones..

A parathyroidectomy is the only effective way to cure hyperparathyroidism. Patients who have overactive parathyroid glands but are not yet experiencing symptoms may still be advised by a physician to undergo a parathyroidectomy to prevent future complications.

Before surgery, imaging tests may be performed to identify the gland or glands that need to be removed. However, imaging techniques are not perfect methods for identifying which gland is overactive and, in most cases, it is more effective for a surgeon to decide which glands to remove during the parathyroidectomy.

The procedure may be minimally invasive if the overactive gland can be identified prior to the procedure. This may be done with the use of a special imaging test called the sestamibi, in which patients ingest a radioactive liquid just before images are taken of the parathyroid area. These images may help guide a physician during surgery. The advantages of a smaller incision with a minimally invasive procedure are a shorter time in the hospital and a smaller scar.

A parathyroidectomy may be performed under general or local anesthesia and takes roughly three hours to perform. During the procedure, the patient is anesthetized and an incision is made near the base of the patient’s neck over one pair of parathyroid glands. If the initial incision reveals the overactive gland and a normal gland, the overactive one is removed. The patient’s PTH level may then be tested and compared to prior readings. If the level has decreased, then the overactive gland causing the increase has most likely been removed and the incision can be closed. In some cases, multiple parathyroid glands may need to be removed or imaging tests may not reveal which one is overactive. For this, a larger, more invasive incision is necessary to access all four glands.

When three and a half or all four parathyroid glands need to be removed from the neck, one may be transplanted to the patient’s forearm. The gland will continue to produce PTH, reducing the risk of hypoparathyroidism (when the glands fail to produce enough PTH). Placing a functioning gland in the arm also allows easy access by a surgeon if it becomes overactive.

Recovery from a parathyroidectomy typically requires an overnight stay in the hospital, although patients who undergo a minimally invasive procedure may be allowed to go home within hours of the operation. Immediately after surgery, a patient’s neck is likely to be swollen, and blood calcium levels may be low until the remaining glands are able to compensate for the removed tissues. These low calcium levels are treated with calcium supplements.

Typically within 24 hours, the patient’s PTH and calcium levels return to normal. Within the next two to three days, the bandages are removed from the neck. A week after the surgery, the patient returns to the physician for a checkup and to have the sutures removed.

The checkup is important because in some cases the remaining parathyroid glands are not able to recover and produce enough PTH. If this occurs, the patient may have signs or symptoms of hypoparathyroidism, such as muscle spasms and tingling in the lips, fingers and toes.

As with all surgeries, there is a risk of complications due to a parathyroidectomy. However, complications are rare. Some of these complications (e.g., blood loss, infection, adverse reaction to anesthesia) may occur with any type of surgery. Other complications are specific to a parathyroidectomy, such as:

• Hoarseness or difficulty swallowing (due to injury to the nerves of the voice box)
  
  
• Hypoparathyroidism (due to too much parathyroid gland being removed)
  
  
• Recurrence of hyperparathyroidism

Although most patients with parathyroid disorders undergo surgical treatment, some patients may have conditions that are not treatable with a parathyroidectomy. This includes people with hypoparathyroidism (underproduction of parathyroid hormone) and certain people with hyperparathyroidism who are not candidates for surgery, such as someone not displaying any symptoms. In these cases, physicians may recommend certain medications to control symptoms of the disorder and avoid potential complications such as hypercalcemia or hypocalcemia (too little calcium in the blood).

Recommendations for people with asymptomatic hyperparathyroidism who chose to forgo surgical treatment include:

• Avoid thiazide diuretics and lithium medications, prolonged bed rest and diets that are high in calcium
  
  
• Be physically active
  
  
• Drink enough fluid and avoid dehydration
  
  
• Consume moderate amounts of calcium and vitamin D
  
  
• Have tests every six months to a year for bone loss and kidney damage

Medications may be used to treat cases of asymptomatic or mild hyperparathyroidism. They do not cure the condition, but reduce its severity. Some medications that may be prescribed in these cases include:

• Calcimimetics. Medications that trigger the parathyroid glands to stop secreting parathyroid hormone (PTH). The Food and Drug Administration (FDA) has approved them only for primary hyperparathyroidism due to parathyroid cancer and secondary hyperparathyroidism occurring with kidney failure being treated with dialysis. They may not be suitable for use in patients with liver disease.
  
  
• Bisphosphonates. Medications used to reduce and help reverse osteopenia (loss of bone density) and osteoporosis. Their effectiveness in treating patients with hyperparathyroidism is still being studied and they may not be suitable for people with kidney problems or women who are pregnant.
  
  
• Estrogen and progestin. Hormones that help reduce bone loss for postmenopausal women. These hormones are typically not recommended because of the associated significant risks of breast cancer, stroke and heart disease.
  

  

Extremely high levels of calcium in the blood may lead to a parathyroid crisis, which can lead to coma. Treatment of a parathyroid crisis requires intravenous fluid administration to reduce the amount of calcium and possibly dialysis. In this case, a parathyroidectomy will likely be necessary.

Treatment for hypoparathyroidism is focused on maintaining normal levels of calcium in the body through the use of medication. There is no surgical option for this condition. Patients with hypoparathyroidism usually require supplements of calcium and vitamin D. These supplements are taken for the rest of the patient’s life to maintain adequate levels of calcium in the bloodstream.

Calcium carbonate is the form of calcium most often used as a supplement. However, absorption of calcium carbonate may be difficult for older patients and those who do not produce much acid in their stomachs. For these people, other forms of calcium, such as calcium citrate and calcium glutamate, are available that may be easier to become absorbed into the body. Some types of calcium supplements may be unsuitable for patients with kidney failure.

Vitamin D or calcitrol (a form of vitamin D) is sometimes also used because it helps the intestines absorb calcium from food and supplements. In addition, patients may be prescribed thiazide diuretics to reduce the amount of calcium that a patient excretes in urine. This reduces the risk of a buildup of calcium in the body, which may lead to hypercalcemia.

Additionally, patients with hypoparathyroidism should consume a diet that is high in calcium and includes foods such as dairy products, certain types of beans, and green, leafy vegetables.

Preparing questions in advance can help patients have more meaningful discussions with healthcare providers regarding their condition. Patients may wish to ask their doctor the following questions about parathyroid treatment:

1. What type of parathyroid treatment do you recommend?
   
   
2. Would a parathyroidectomy cure my hyperparathyroidism?
   
   
3. Should I have imaging tests to pinpoint which parathyroid glands are overactive?
   
   
4. If I have no symptoms, what are the risks and benefits to me of having a parathyroidectomy now?
   
   
5. What are the risks and benefits if I wait to get a parathyroidectomy?
   
   
6. If I delay getting a parathyroidectomy, how will I know when it is necessary?
   
   
7. Am I a candidate for a minimally invasive procedure?
   
   
8. Do I have other treatment options? What are the risks associated with them?
   
   
9. What are the chances my hyperparathyroidism will return?
   
   
10. Are there any long-term risks associated with my parathyroid treatment?