The problem is almost always hyperfunctioning parathyroid glands. Because the hipoparathyroidism is often due to the insufficiency of the healthy glands that remain after an unavoidable complication of guatr or thyroid surgery, or the removal of abnormally functioning parathyroid glands. Other reasons than these are extremely rare.
Hyperparathyroidism leads to excessive rise in blood calcium levels as a result of the excessive excretion of parathormones (PTH). Routine blood tests reveal co-incidental hypercalcemia (abnormally elevated blood calcium level) in recent years. This is actually a good development in terms of early diagnosis of the disease. So many patients don’t have any complaints of hyperparathyroidism. It generally occurs in one in 1,000 people. It’s more severe in women. And it grows with age. For example, in women 60 to 70 years of age or older, it occurs as much as 1/300. I mean, it’s not uncommon at all.
From here, if there is an abnormal increase in blood calcium, the most likely cause is hyperparathyroidism.
And what happens when the disease is confirmed?
Kidney and urinary stone formation and related problems, hypertension in almost every patient, bone loss (osteoporosis), some unexplained mental problems.
In advanced cases, a person’s bones are easily broken. For example, a simple fall can result in an unexpected fracture. Although not all of this, many patients turn to the doctor with complaints of muscle weakness, insufficiency, loss of appetite, and too frequent urination and nausea.
The only effective treatment for a disease called primary hyperparathyroidism is the removal of an abnormally functioning parathyroid gland or glands. In this form, the problem is caused by 80-85% adenoma, 15% hyperplasia, and 1-4% parathyroid cancer. One out of every six or seven people affected by this disease is to have more than one gland at the same time.
A WELL-OPERATED SURGERY IS HIGHLY CURATIVE
After surgery, the complaints ie weakness, muscle pain, sleep disorders, urination promlems are disappear in a significant degree. The bone mineral loss stops or at least, progression stops. Dangerously rise in blood calcium (particularly over 13 mg/dl) is prevented. If the high blood pressure is present before the surgery, the diseased glands are removed, but the blood pressure problem may persists. It is necessary to clarify before the operation whether the level of blood calcium depends on another cause. Some family diseases, such as cancer, hyperthyroidism, excessive milk consumption and hypercalcemia, should be investigated.
Surgery should be performed in following conditions:
– Presence of stones in the urinary tract, stomach ulcers, widespread pain in the bones, muscle weakness, high blood pressure.
– The presence of hyperparathyroidism without any complaints also requires surgery:
- Being younger (under 50 years of age)
- Calcium levels in the blood exceed as much as 1 mg of the normal limit
- 400 mg of calcium excreted in the urine per day
- 30% decrease in kidney functiond
- decrease in bone density
What tests are required before surgery?
– A high-quality cervical ultrasound –
– Special syntigraphic examination (Tc 99-SestaMIBI)
– Sometimes tomography and SPECT BT
Surgeon’s experience is extremely important. In a sense, the surgeon’s experience is much more important than the experience of a particular hospital or center (MY OPINION). Because the inadequacy of initial surgery makes it much more difficult for subsequent surgeries to be performed. Because there is a certain rate of recurrence of the disease, and even during surgery, the affected gland cannot be found despite all the searches.
Surgical success is extremily important, But there is no guarantee for experienced surgeons. For example, in a person who has three hyperfunctioning organs, the surgeon may not be able to find the third organ after finding two organs. The affected organ can be found in many different places: inside the thyroid gland, behind the esophagus, in the chest cavity, right above the heart and even in the abdomen. However, these types of situations are quite rare.
There are two different surgical tactics!
- Minimally invasive surgery or focued surgary (I am in favour of this method if the circumstances are appropriate). Here, a small incision of 2-3 cm of skin is found and removed directly from the affected organ. During surgery, PTH is measured to determine if there is an another affected gland in the back. This procedure requires pre-operative SestaMIBI scintigraphy and high sonography to determine the affected organ!. Otherwise, the method cannot be applied.
- Bilateral neck exploration: this technique base on the surgical evaluation of whole parathyroid glands and removal of abnormal one/s. This surgery is highly classical and a time consuming procedure. However, multiglandular diseases (MEN syndromes and other hereditary parathyroid diseases, tertiary hyperparathyroidism) always require this classic technique.
I personally believe that intraoprative PTH monitorization shoul be done for all kind of hyperparathyroidism.