Parathyroid disease refers to conditions where the four small glands in the neck, which regulate the body’s calcium and phosphorus levels, malfunction. The most common form, primary hyperparathyroidism, occurs when one or more glands produce excessive parathyroid hormone (PTH), leading to abnormally high calcium in the blood. Since this imbalance affects the skeletal, renal, and nervous systems, treatment requires a coordinated team of medical and surgical specialists.
The Initial Diagnosis and Medical Management
The first professional to suspect parathyroid disease is often the primary care physician, who orders routine blood work that reveals elevated serum calcium levels. When hypercalcemia is detected, the patient is referred to an endocrinologist, a specialist in hormonal and metabolic disorders, who confirms the diagnosis. The endocrinologist performs specialized blood tests to measure parathyroid hormone (PTH) alongside calcium. A diagnosis of primary hyperparathyroidism is confirmed when both PTH and calcium are elevated, or when PTH is inappropriately normal despite high calcium.
The endocrinologist determines if the patient is a candidate for non-surgical management for mild cases. This management includes regular monitoring of calcium levels, kidney function, and bone mineral density using a dual-energy X-ray absorptiometry (DXA) scan. For patients who cannot undergo surgery or are awaiting the procedure, medications like calcimimetics (e.g., cinacalcet) may be prescribed to lower blood calcium. Bisphosphonates may also be used to protect bone density and prevent skeletal damage caused by chronic high PTH levels.
Specialists Who Perform Parathyroid Surgery
For most patients with confirmed primary hyperparathyroidism, the definitive cure is surgical removal of the overactive gland or glands, a procedure called parathyroidectomy. This operation is performed by highly trained surgeons, often specializing in the head and neck area. The best outcomes are achieved by endocrine surgeons, who have completed additional fellowship training in surgeries of the thyroid, parathyroid, and adrenal glands. These surgeons perform a high volume of parathyroid procedures, which leads to better success rates and lower complication risks.
While some general surgeons and ear, nose, and throat (ENT) surgeons also perform parathyroidectomy, those with dedicated endocrine surgery experience are preferred due to the small size and variable location of the glands. Before the operation, the surgical team relies on specialized imaging, such as a Sestamibi scan or a high-resolution neck ultrasound, to locate the abnormal gland. Minimally invasive parathyroidectomy techniques, guided by pre-operative localization and intraoperative PTH monitoring, allow the surgeon to remove the diseased tissue through a small incision. This focused approach minimizes recovery time and reduces the risk of complications, such as damage to the recurrent laryngeal nerve.
Comprehensive Care and Long Term Monitoring
A multidisciplinary approach is necessary for managing parathyroid disease. The radiologist plays a role by performing sophisticated diagnostic imaging, such as the Sestamibi scan, which uses a radioactive tracer to highlight the hyperfunctioning gland. Radiologists also interpret bone density scans to assess the long-term effects of the disease on the skeleton. A nephrologist, a specialist in kidney health, may be involved if high calcium levels have led to complications like kidney stones or impaired kidney function.
Following a successful parathyroidectomy, the endocrinologist and primary care physician collaborate on long-term follow-up care to ensure the disease does not recur and to manage residual health issues. Calcium levels are checked regularly, often annually, to confirm the cure is sustained. Repeat bone density testing is also recommended to track the recovery of bone health, which typically improves after the source of the high PTH is removed.