Parathyroid gland disorders

Written by Dr Colin Paterson, consultant physician

What are the parathyroid glands?

Most people have four small glands in the neck - two on either side - usually situated near the thyroid gland. They are too small to be seen or felt and have no functional connection with the thyroid but they adjust the level of calcium in the blood.

If the blood calcium goes down the, glands produce more parathyroid hormone, which raises the blood calcium in various ways.

What happens if the blood calcium goes up or down?

In some illnesses, such as overactivity of a parathyroid gland, the blood calcium rises above the normal level. Small rises may cause no symptoms but with a large one people may experience nausea, vomiting and constipation ; and pass large amounts of urine.

In another group of disorders, including underactivity of the parathyroid glands, the blood calcium falls below the normal range. This may lead to 'pins and needles' in the face, hands or feet; muscle spasms in the hands, known as tetany; as well as fits.

Why do parathyroid glands become overactive?

This condition, known as hyperparathyroidism, is usually caused by a benign tumour in one of the glands. This secretes more parathyroid hormone than is needed and the blood calcium rises.

How is hyperparathyroidism treated?

For most patients the best treatment is surgery to remove the affected gland. But it may not be suitable for some people, depending on their age, their blood calcium level and whether they have any other medical conditions.

People who do not have surgery need to be kept under surveillance with occasional checks on blood chemistry.

Why do parathyroid glands become underactive?

This condition, known as hypoparathyroidism, most commonly occurs after operations on the neck related to disorders of the thyroid or larynx. The glands may be removed or their blood supply impaired. Sometimes, when an extensive operation is needed, it is impossible for the surgeon to preserve the parathyroids.

How is hypoparathyroidism treated?

The usual treatments involve either vitamin D (calciferol) or a medicine known as alfacalcidol (eg One-Alpha or AlfaD). This is converted in the body to a form of vitamin D. Parathyroid hormone cannot be used in treatment.

calciferol: about 1.25/mg daily

alfacalcidol: 0.5 to 2.0/mg daily.

With either medicine, the blood calcium must be checked regularly especially in the early months of treatment as the effect of a particular dose may not be clear for some weeks. The sensitivity of the body to these drugs may also change if other drugs (such as hormones) are given or withdrawn.

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