Primary Hyperparathyroidism and Parathyroid Tumors
Overview
Hyperparathyroidism has 2 main causes:
- Primary hyperthyroidism (PHPT) is caused by a tumor or something else that’s not normal on the parathyroid gland.
- Secondary hyperparathyroidism is not caused by the parathyroid gland. Secondary hyperparathyroidism is caused by other things, including chronic kidney disease and vitamin D deficiency (too little vitamin D). These problems make the parathyroid gland produce extra parathyroid hormone.
About the parathyroid gland
There are 4 tiny parathyroid glands. Each one is about the size of a grain of rice. The parathyroid gland is in the neck, behind the thyroid gland.
The parathyroid gland helps regulate (control) the amount of calcium in the blood. This gland controls how much parathyroid hormone (PTH) your body makes. It adjusts the amount, based on how much calcium is in your bloodstream.
- When there’s too little calcium, the parathyroid gland makes more PTH. Your body makes more calcium.
- When there’s too much calcium, the parathyroid gland makes less PTH. Your body makes less calcium.
The location of parts of the thyroid, including parathyroid, lobes, thyroid gland, and lymph nodes.
Sometimes the parathyroid can become overactive. When that happens, the gland makes too much PTH. The large amount of PTH causes your bones to release too much calcium into your blood. Your body has an elevated (higher than normal) calcium level. The high calcium level means more calcium gets filtered through your kidneys and into your urine.
That’s why parathyroid disease tends to cause weakened bones and kidney disease.
If you have a mutation (change) in the MEN1 gene, this means you have a condition called multiple endocrine neoplasia type 1. It can cause primary hyperparathyroidism (PHPT). MEN1 mutations raise your chance of getting parathyroid hyperplasia. This is when more than 1 parathyroid gland is overactive.
Symptoms of hyperparathyroidism, and how it’s diagnosed
Here are the most common symptoms of primary hyperparathyroidism:
- Broken bones.
- Osteoporosis that’s diagnosed with bone mineral density testing at the spine, hip, and maybe forearm. You may have a dual-energy X-ray absorptiometry (DEXA) scan. This is a radiology test to assess your bone density. A DEXA scan is quick, painless, and uses only a little radiation. It will scan you for signs of weaker bones.
- Kidney stones.
- Your kidneys do not work very well. Your body can fill with water and waste.
- Muscle weakness.
- Memory problems.
- You urinate (pee) too much.
- Bone or joint pain.
- Nausea (feeling like throwing up), vomiting (throwing up), or other gastrointestinal problems.
Signs of parathyroid tumors often look like the symptoms of other health problems. If you have any of these symptoms, talk with your healthcare provider.
How primary hyperparathyroidism is diagnosed
Primary hyperparathyroidism (PHPT) is diagnosed using blood tests. We check your calcium and parathyroid hormone levels using a blood test called PTH, intact.
If the blood tests show you have PHPT, your doctor will order a parathyroid imaging scan. This imaging test will show which glands are overactive.
Imaging scans also will show if you have abnormal (not normal) glands. About 10 to 20 out of every 100 people with PHPT have more than 1 parathyroid gland that’s not normal. It can be in the wrong location, such as near your esophagus (food pipe) or chest.
Parathyroid imaging scans include:
- CT scans.
- Ultrasound.
- Parathyroid nuclear scans, which use a small amount of a radioactive substance. This scan is called a sestamibi (SES-tuh-MIH-bee) scan, or MIBI.
- Venous sampling, a very rare procedure. It’s only used if the parathyroid tumor is hard to find or you already had parathyroid surgery.
Types of parathyroid tumors
Most parathyroid tumors are not cancer. They do not spread to other parts of the body.
Parathyroid adenoma
Parathyroid adenoma, a type of parathyroid neoplasm, is another name for a benign (not cancer) parathyroid tumor. Adenoma is a benign tumor that starts in glandular tissue. Surgery is the most common treatment for an enlarged (very big) gland.
Parathyroid cancer
Parathyroid cancer is very rare. It only happens to about 1 out of every 100 people with primary hyperparathyroidism. If your doctor thinks a tumor is cancer, they’ll do surgery to remove the parathyroid tumor. Often, they’ll also take out part of the thyroid gland and nearby lymph nodes.
Treatment for primary hyperparathyroidism
Surgery is the most common treatment for parathyroid tumors. It’s often the best treatment for both benign tumors and tumors with cancer.
Active surveillance is another treatment for parathyroid tumors. It’s also called watchful waiting. MSK experts will monitor, or watch, for signs over time that the tumor needs treatment. You’ll get regular scans and tests.
Based on your bone density scan, your doctor may recommend medicine to protect your bones. This medicine lowers the chance your bones will fracture (break).
Your calcium level may be too high to safely monitor, but surgery is not a good treatment for you. If this happens, your doctor may prescribe medicine to lower your blood calcium level.
In general, MSK doctors recommend surgery for people who:
- Are young.
- Have osteoporosis.
- Are at a high risk for kidney stones.
- Have a high calcium level on blood tests that’s too high to safely monitor.
- Have kidneys that do not work as well as they should.
What is parathyroid surgery?
Your surgeon will remove the parathyroid tumor through a small incision (cut) in the neck, just below the Adam’s apple. During surgery, your care team closely monitors your parathyroid hormone level.
After they remove the tumor, the PTH level in the bloodstream should drop right away. Your surgeon finishes the operation once the hormone level is back to normal.
After surgery, your care team closely monitors calcium and PTH levels.
Some people also need treatment for osteoporosis or kidney stones. You’ll start treatments after you recover from surgery. For most people, your bone density improves after surgery.
Parathyroid surgery most often takes about 20 to 40 minutes.
MSK’s parathyroid surgeons use minimally invasive methods. Most often, they can remove parathyroid tumors through very small incisions (cuts) in the neck.
They often make these cuts in natural skin creases, so any scarring is hard to see. Sometimes we can remove a parathyroid tumor using special tools. Your incision will be even smaller.
Recovery from parathyroid surgery is different for everyone. Most people start to have a little more energy each day in the weeks after surgery. Some people find that their energy level goes up or down for 1 to 2 months after parathyroid surgery.
Common questions
Yes. Your doctor will measure your calcium and parathyroid hormone levels. They will guide how your doctor diagnoses an overactive parathyroid gland.
Active surveillance is also called watchful waiting. Your care team will assess whether you need surgery years later.
Researchers are exploring how to predict the chance someone in active surveillance will need surgery. One research study suggests about 1 out of every 3 people will need parathyroid surgery during 10 years of monitoring.
MSK has treatment locations in New York City, Westchester, on Long Island, and in New Jersey.
At our locations, you can meet with your care team and get treatment. MSK brings its expert care closer to you so you can get back home to what matters most.
MSK has more than 70 head and neck cancer experts. We see more people with rare types of head and neck cancer than many other cancer centers. We’re experts in diagnosing and treating rare salivary gland, mouth, and thyroid cancers. That’s why 1,100 people with rare head and neck cancers come to MSK each year.