Primary hyperparathyroidism

The main disease of the parathyroid glands is hyperactivity of one or more of them. They make  too much PTH, which leads to an increase in the level of calcium in the blood. This is called hyperparathyroidism. The “primary” form is the most common and is the direct result of a problem with the parathyroid glands themselves. The main manifestations are in the bones and kidneys. Calcium levels can be very high (sometimes dangerously so) or a bit high, or even within normal limits (if the kidneys remove a lot of calcium, for example).

Surgical treatment of primary hyperparathyroidism

Only parathyroid surgery can cure primary hyperparathyroidism. After making a small incision in the neck, the surgeon removes one or more hyperactive parathyroid glands.  Some elderly patients who do not have complications related to hyperthyroidism  can still benefit from simple monitoring with blood tests every 6-12 months and bone density measurements  every 2-3 years. Their calcium values and PTH levels must also be only slightly elevated.

There are medications that can lower the level of calcium (and PTH) in the blood. Since they have many side effects and do not improve the amount of calcium in the bones, they are reserved for exceptional situations. Medicines that increase bone mineral density are sometimes used. However, they are less effective than surgery because they do not act over the long term on calcium/PTH levels and other symptoms of primary hyperparathyroidism.

Secondary” hyperparathyroidism  is much more rare.  In this case, the parathyroid glands are stimulated because of another medical problem (e.g. kidney or bowel disease).

Primary and secondary hyperparathyroidism are benign in more than 99% of cases.

Hypoparathyroidism refers to the absence of functionality of the parathyroid glands. This is most often a complication of thyroid removal surgery. It causes very unpleasant symptoms due to low calcium levels (muscle cramps, tingling in the lips, fingers and feet, etc.).

Learn more: The Endocrinology Unit at the HUG.

The Thoracic and Endocrine Surgery Division at the HUG conducts important research to reduce the risk of hypoparathyroidism after thyroid surgery. It is one of the world leaders in this field.

Parathyroid carcinomas

These are very rare and are treated in the same way as primary hyperparathyroidism.

Last update : 15/08/2019