Parathyroid Surgery/ Parathyroidectomy

When is parathyroid surgery advisable?

Parathyroid surgery is indicated when there is an elevated calcium level in the blood (hypercalcaemia) due to over-activity of one or more of the parathyroid glands (hyperparathyroidism).

Hyperparathyroidism causes osteoporosis/ kidney stones/ other symptoms

Parathyroid hormone stimulates the release of calcium from the bones which are the main store for calcium in the body.  Too much of this hormone weakens them (osteoporosis) and increases the risk of fractures particularly affecting the weight-bearing bones such as at the hip and the vertebrae.

The extra calcium appearing in the blood is excreted in the urine and this causes a slowly reduction in  the total amount of calcium in the body.  Calcium within the urine may precipitate in the kidneys themselves or within the drainage system to form “kidney stones” which are not only very painful to pass but also can damage the kidneys themselves. Abdominal discomfort may also occur due to an increased rate of stomach ulcers, inflammation of the pancreas (pancreatitis) and constipation.

Furthermore, people with hypercalcaemia often feel slightly fatigued and depressed with reduced levels of concentration.  These symptoms may be very subtle and certainly may otherwise be due to life pressures. Often it is only restrospectively after abnormal parathyroid gland(s) are removed and a patient feels rejuvenated that the chronic effects of the condition are realized.  I have seen this effect many times with my older patients.

Is surgery really necessary?

A few years ago patients were only operated on when they had obvious signs or symptoms of hyperparathyroidism such as bone fractures, kidney stones, abdominal pain or bone pains.  Now we realize that patients may have subtle symptoms such as lethargy and reduced thought clarity - the presence of which only becomes evident once the disorder is corrected. After surgery these patients simply feel better in themselves.

Also, now with bone density studies being done on post-menopausal women, more and more cases of osteoporosis and hyperparathyroidism are being diagnosed.

While some drugs can lower the level of blood calcium they are only used in the short term and surgery remains the definitive treatment.