Parathyroid disease is a serious condition of the parathyroid gland that can progress without being detected.
The parathyroid gland is mainly responsible for controlling the levels of calcium circulating in the bloodstream. If the calcium levels are low, the gland increases the release of parathyroid hormone. This hormone then signals the bone to release calcium.
In some cases, because of certain problematic conditions, overproduction of parathyroid hormones occurs. This creates trouble in the body especially if this situation is prolonged.
There are several diseases associated with the parathyroid glands. This includes parathyroid cancer and hyperparathyroidism. The primary disease associated with parathyroid disease is hyperparathyroidism.
Hyperparathyroidism is a disease of the parathyroid gland where there is hyperactivity of one or more lobes of the gland causing an increase in the release of the parathyroid hormone. The increase of this hormone in the bloodstream entails that the calcium levels circulating in the body also increase. This poses a deleterious effect in the body.
This disease mainly affects individuals over the age of 50 (See: Thyroid symptoms). Young people may also be affected.
Three Types of Hyperparathyroidism
Primary hyperparathyroidism, secondary hyperparathyroidism, and tertiary hyperparathyroidism are the three types of this disease.
Primary hyperparathyroidism is the most common type of this disease. This is mainly caused by either the presence of an adenoma or hyperplasia. Hyperplasia means that all of the four lobes of the parathyroid gland are affected. Females at their post-menopausal period account for almost 75 per cent of the cases.
On the other hand, secondary hyperparathyroidism is the form wherein the problem is caused by organ failure. The most common cause is renal dysfunction. Other diseases such as Paget’s disease and osteogenesis imperfecta may also affect the parathyroid gland. In this form, excessive production of the parathyroid hormone is in response to low calcium levels in the body.
Lastly, tertiary hyperparathyroidism happens because of a long period of renal failure. In other words, it is a product of long-term secondary hyperparathyroidism.
Parathyroid carcinoma is a rare disorder of the parathyroid gland. This condition is malignant and may pose more difficulties than hyperparathyroidism since this can metastasize and affect neighboring tissues. This disease is also characterized by a large amount of parathyroid hormone circulating in the body.
Clinical Feature of Parathyroid Disease
At an early stage of hyperparathyroidism, the patients don’t experience any symptoms. When the body is exposed to prolonged high levels of calcium, wide varieties of signs and symptoms may appear. These symptoms are very vague since these features can also be observed in other diseases. Some individuals may experience mental and physical symptoms.
Psychological features include: depression, anxiety, fear, and poor, short-term memory.
Physical symptoms may be comprised of having stones in the kidneys. Heart palpitations and acid reflux may also be present. Muscle weakness and fatigue is also commonly observed.
At later stages of this kind of parathyroid disease, osteoporosis and renal failure may develop.
Similarly, the clinical features of parathyroid cancer are the same as hyperparathyroidism except that it is more severe.
Parathyroid disease is a slowly progressing disease. That is the reason why the clinical features may be observed ten years after the onset of the disease.
Diagnosis of Parathyroid Disease
Commonly, parathyroid diseases can remain undetected for years. But certain professionals have the capacity to make an initial diagnosis.
Dental practitioners may have the ability to recognize parathyroid disease through regular dental checkups. Oral examinations should not be only limited to ocular examinations but also through radiographic examinations.
In the radiographs, the density of the bone around each tooth is less dense than normal. Cysts and altered lamina dura are indicative for the presence of the disease.
A definitive diagnosis can be made by undergoing two laboratory examinations. These are a serum calcium exam and a serum parathyroid hormone test. The tests should be done several times. When both tests are high, the person has hyperparathyroidism. When both tests are extremely high, the problem may point to parathyroid cancer.
Other laboratory tests such as a 24-hour urine calcium exam are also made. The calcium level in the urine is always high in most cases of hyperparathyroidism.
Treatment of Parathyroid Disease
The treatment for hyperparathyroidism and parathyroid cancer has been always surgical removal of the parathyroid gland. This is called parathyroidectomy. This can either be a partial removal or a complete removal of the parathyroid gland.
Almost 90 per cent cases of hyperparathyroidism have only one lobe that is overproducing parathyroid hormones. This type of case is indicative for a partial parathyroidectomy.
A complete parathyroidectomy is also done in rare cases. Involvement of four lobes of the parathyroid gland may be indicated for this type of treatment.
In patients who are experiencing a mild form of hyperparathyroidism, surgical removal of the gland may also be indicated. However, some patients refuse to do this treatment. Taking prescribed medications and undergoing regular examinations are other treatment options.
Regular examinations include checking the parathyroid levels every six months. Calcium levels should also be examined. Radiographic analysis of bone density is also made.
In patients with parathyroid cancer, radiation therapy and chemotherapy may also be needed.
Complications of Parathyroidectomy
In cases of partial or complete removal of the parathyroid gland, another problem may arise. Because of a lack of the parathyroid hormone, this may eventually develop into another problem called hypoparathyroidism.
The patient may experience this temporarily or permanently.
When permanent hypoparathyroidism occurs, additional medication is needed to be taken to make the parathyroid hormones reach normal levels. The patient may also undergo organ transplantation.
Paralysis of the vocal cords and hematomas are also other complications of a parathyroidectomy.
Early detection of parathyroid disease and any other disease has always been best. This halts the progression of the disease and prevents serious complications. In the case of hyperparathyroidism, early detection prevents osteoporosis and renal dysfunction.