Primary Hyperparathyroidism and Parathyroid Tumors

Primary Hyperparathyroidism and Parathyroid Tumors

Parathyroid tumor surgeon Brian Untch

MSK’s world-class head and neck surgeons, including Brian Untch, have particular expertise in removing parathyroid tumors.

Hyperparathyroidism is a condition in which the parathyroid gland becomes overactive. When that happens, it produces too much parathyroid hormone. Parathyroid disease can lead to a number of health problems. These include osteoporosis and kidney stones.

Hyperparathyroidism has two main causes:

  • a tumor or other abnormality on the parathyroid gland
  • another condition, such as chronic kidney disease or a vitamin D deficiency, that can affect the function of the parathyroid gland

Hyperparathyroidism due to a tumor or other abnormality is known as primary hyperparathyroidism. Hyperparathyroidism brought on by another condition is called secondary hyperparathyroidism.

At Memorial Sloan Kettering, we are highly experienced in caring for people with hyperparathyroidism. Our team includes head and neck surgeons, endocrinologists, radiologists, and pathologists. We are committed to providing state-of-the-art care for people with the disease. We also have expertise in monitoring a rare genetic condition called multiple endocrine neoplasia type 1 (MEN1). This condition makes it more likely that someone will develop primary hyperparathyroidism.

Learning as much as you can about your diagnosis can help you feel better prepared to speak with doctors about your possible treatment options and care. This guide, which focuses on primary hyperparathyroidism, is a good place to begin.

About the Parathyroid Gland

The parathyroid gland consists of four tiny glands, each about the size of a grain of rice, located in the neck, behind the thyroid gland.

The parathyroid gland plays an important role in regulating the amount of calcium in the blood. It controls the production of parathyroid hormone (PTH) in response to the amount of calcium in the bloodstream. When there is too little calcium, the parathyroid gland makes more PTH. This stimulates calcium production. When there’s too much calcium, the parathyroid gland reduces how much PTH it makes. Calcium production is then reduced too.

Sometimes the parathyroid can become overactive. When that happens, the gland makes too much PTH. The excess parathyroid hormone causes the bones to release excess calcium into the blood. It also reduces the amount of calcium released by the kidneys into the urine.

As a result, parathyroid disease has a tendency to cause symptoms related to weakened bones and kidney disease.

Primary Hyperparathyroidism Symptoms

The most common symptoms of hyperparathyroidism are:

  • broken bones
  • osteoporosis on bone mineral density testing at the spine, hip, or forearm
  • kidney stones
  • significantly reduced kidney function
  • weakness
  • memory problems
  • excessive urination
  • bone or joint pain
  • nausea, vomiting, or other gastrointestinal problems

Symptoms of parathyroid tumors often resemble those caused by other conditions. If you experience any of these symptoms and have concerns, speak with your doctor.

Types of Parathyroid Tumors

Most parathyroid tumors are not cancerous. They do not spread to other parts of the body.

Parathyroid Adenoma

Parathyroid adenoma is another name for a benign (not cancerous) parathyroid tumor. Adenoma refers to a benign tumor that begins in glandular tissue.

Parathyroid Cancer

Parathyroid cancer is a rare condition. It occurs in only about 1 percent of people with primary hyperparathyroidism. If doctors believe a tumor is cancerous, the tumor is removed, often with part of the thyroid gland and surrounding lymph nodes.

Primary Hyperparathyroidism Diagnosis

Blood tests are needed to diagnosis primary hyperparathyroidism. Both calcium and parathyroid hormone levels are checked.

Once a diagnosis is made, imaging tests help doctors determine which gland or glands are causing the problem. Between 10 and 20 percent of people with primary hyperparathyroidism have more than one abnormal parathyroid gland.

Imaging tests that doctors might recommend include:

  • a CT scan
  • an ultrasound
  • a sestamibi scan
  • venous sampling (this is used in rare situations when the parathyroid tumor is difficult to locate or the patient has already had a parathyroid surgery)
Can I have an overactive parathyroid gland even though my level of parathyroid hormone is considered normal?

Answer: Yes. The combination of calcium and parathyroid hormone levels will guide your doctor in diagnosing an overactive parathyroid gland.

Primary Hyperparathyroidism Treatment

Many people with parathyroid tumors have surgery. It is often very effective at treating both noncancerous and cancerous tumors.

Active surveillance for parathyroid tumors is another option. This approach involves closely monitoring your condition over time.

In general, MSK’s doctors recommend surgery for people who:

  • are young in age
  • have osteoporosis
  • are at a high risk of kidney stones
  • have a high calcium level on blood tests (too high to safely monitor)
  • have reduced kidney function
If I don’t need parathyroid surgery now, what are the chances I will need it in the future?

Answer: Doctors are still working to understand the likelihood that active surveillance patients will need surgery down the road. The current available evidence is limited to a small number of people. One study suggests that about a third of patients will require parathyroid surgery over the course of ten years of active surveillance.

Parathyroid Surgery

Surgery involves removing the parathyroid tumor through a small incision in the neck, just below the Adam’s apple. While removing the tumor, the surgical team monitors the parathyroid hormone level very closely.

Once all abnormal tissue has been successfully removed, there should be an immediate drop in the PTH level in the bloodstream. The surgeon completes the operation once the hormone level has returned to normal.

After surgery, our care team closely monitors calcium and PTH levels. If additional treatment for osteoporosis or kidney stones is required, our patients begin those therapies after recovering from the operation. Bone density improves for most people after surgery.

Minimally Invasive Surgery Options

MSK’s parathyroid surgeons have studied minimally invasive techniques extensively. We typically remove parathyroid tumors through very small incisions in the neck. Usually these cuts are made in natural skin creases so any scarring is hard to see. In some cases, a parathyroid tumor may be removed using tools to keep the incision even smaller.

Recovery from Parathyroid Surgery

Recovery from parathyroid surgery is different for everyone. Most people notice their energy gradually returning in the weeks after surgery. Some people find that their energy level varies for a month or two.

Support Services

Even after you’ve finished treatment, you may still need our help. We’re committed to supporting you in every way we can — physically, emotionally, spiritually, and otherwise — for as long as you need us.

Learn more about ways we can help support you during and after treatment for a parathyroid tumor.

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