The parathyroid gland is not one but four glands that are sited next to the thyroid gland, hence it’s name para(next to)thyroid glands. However, other than the anatomical relationship of the glands, the thyroid and parathyroid glands have nothing else in common. The parathyroid glands produce a small size protein called parathyroid hormone(PTH).
PTH is responsible for maintaining the calcium balance in the bloodstream. If there is insufficient PTH, the calcium will drop and if it’s too much, the calcium levels will rise.
When the parathyroid gland enlarged, it is usually due to a single gland enlargement, called a parathyroid adenoma( and very rarely parathyroid carcinoma/cancer). When there is prolonged renal failure, all the 4 glands can secondarily enlarged due to low blood calcium. The latter is called parathyroid hyperplasia. The result of an enlarged parathyroid gland is the over production of parathyroid hormone. A high level of PTH results in mobilization of the calcium from its storage (usually the bone) into the bloodstream, and is filtered by the kidneys. High calcium also affects the stomach lining and mental status.
The patient with abnormally high calcium in patients present with renal stones, gastric ulcers, fractures or even
depression.
The diagnosis is usually found first due to a high calcium level and localized with the help of a parathyroid scan.
The sestamibi tehnicium subtraction scan is only add aid but does not replace the surgical skill needed to localize
the diseased parathyroid gland.
The treatment is surgical removal of the abnormal parathyroid if it’s one lesion or all of the 4 enlargement in
hyperplasia. The treatment results depends on the difficulty of locating the parathyroid, hence it depends on
surgical expertise of the surgeon.
