Hyperparathyroidism Treatment in Corpus Christi, TX
Hyperparathyroidism is a condition in which one or more of the four parathyroid glands small endocrine glands located on the posterior surface of the thyroid gland in the neck produce excessive amounts of parathyroid hormone (PTH). PTH regulates calcium and phosphate homeostasis; when PTH is overproduced, it causes hypercalcemia (elevated blood calcium) that, if untreated, leads to progressive end-organ damage affecting the kidneys, bones, gastrointestinal tract, and cardiovascular system. At Corpus Christi ENT Sinus & Allergy, Dr. Todd M. Weiss provides expert surgical management of primary hyperparathyroidism.
Types of Hyperparathyroidism
Primary Hyperparathyroidism
Primary hyperparathyroidism (PHPT) is the most common form and the focus of surgical management. It results from autonomous overproduction of PTH by one or more abnormal parathyroid glands, independent of physiologic calcium regulation. Causes include:
- Parathyroid adenoma: a benign tumor of a single parathyroid gland, accounting for approximately 85 to 90 percent of PHPT cases
- Parathyroid hyperplasia: diffuse enlargement of all four glands, accounting for approximately 10 to 15 percent of cases; may be sporadic or associated with MEN1 or MEN2A syndrome
- Parathyroid carcinoma: a rare but malignant cause of PHPT, accounting for less than one percent of cases
Secondary Hyperparathyroidism
Secondary hyperparathyroidism occurs as a physiologic response to chronic hypocalcemia most commonly caused by chronic kidney disease, vitamin D deficiency, or malabsorption syndromes. All four glands enlarge in response to the stimulus for increased PTH production. Treatment is directed at the underlying cause.
Tertiary Hyperparathyroidism
Tertiary hyperparathyroidism occurs when secondary hyperparathyroidism (typically from chronic renal disease) becomes autonomous persisting or worsening after the underlying cause (e.g., after kidney transplantation) has been corrected. Surgical management is often required.
Symptoms of Primary Hyperparathyroidism
Primary hyperparathyroidism is increasingly discovered incidentally on routine laboratory testing in asymptomatic patients. When symptoms are present, they reflect the effects of hypercalcemia and elevated PTH on target organs:
- Fatigue, weakness, and cognitive changes (‘bones, stones, groans, and psychic moans’)
- Bone pain and osteoporosis — from PTH-mediated bone resorption
- Nephrolithiasis (kidney stones) — from hypercalciuria; the most common symptomatic presentation
- Nephrocalcinosis — calcium deposition within the kidney parenchyma
- Gastrointestinal symptoms: nausea, constipation, anorexia, and peptic ulcer disease
- Cardiovascular: hypertension and shortened QT interval on electrocardiogram
- Depression, anxiety, and cognitive impairment
Diagnosis
The biochemical diagnosis of PHPT requires the demonstration of elevated or inappropriately normal PTH in the setting of confirmed hypercalcemia (elevated serum total calcium or ionized calcium). Additional evaluation includes 24-hour urine calcium (to distinguish PHPT from familial hypocalciuric hypercalcemia), serum vitamin D level, bone density (DEXA) scan, and renal ultrasound or abdominal CT to assess for nephrolithiasis.
Parathyroid Localization Imaging
Preoperative localization of the abnormal gland(s) is performed using:
- Neck ultrasound: identifies enlarged parathyroid glands adjacent to the thyroid in most cases
- MRI: used selectively for patients with discordant localization results or prior neck surgery
- Sestamibi parathyroid scintigraphy (parathyroid scan): a nuclear medicine study using technetium-99m sestamibi that preferentially accumulates in hyperfunctioning parathyroid tissue
- 4D CT scan of the neck: provides detailed anatomical localization and is particularly useful for ectopic or multigland disease
Surgical Treatment
Parathyroidectomy is the only curative treatment for primary hyperparathyroidism. Current standard of care is minimally invasive parathyroidectomy (MIP) a focused, outpatient procedure in which the single abnormal gland identified on preoperative imaging is removed through a small neck incision. Intraoperative PTH monitoring confirms successful gland removal (a greater than 50 percent drop in PTH within 10 minutes of excision confirms cure). Cure rates for MIP in single-gland adenoma exceed 95 percent.
For multigland disease, bilateral neck exploration with identification of all four glands is performed. Dr. Weiss will review localization imaging, discuss the surgical approach, and outline expected outcomes and risks during your pre-operative consultation.
Medical Management for Asymptomatic PHPT
Asymptomatic patients who do not meet surgical criteria (established by international guidelines) may be managed with surveillance periodic monitoring of serum calcium, PTH, renal function, and bone density. Medical therapy with bisphosphonates (for bone protection) or cinacalcet (a calcimimetic agent that lowers PTH and calcium) may be appropriate for selected patients who are not surgical candidates.
Schedule an Appointment Today
If blood work has shown elevated calcium or PTH, or you’re experiencing fatigue, kidney stones, or bone loss, an evaluation is important. Call us at (361) 320-6130 or connect with us online to schedule a consultation.