HEAD AND NECK

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The parathyroid glands produce the PTH which is responsible for the control of calcium in human organism.  They are located in the neck in close contact with the thyroid gland and are usually four in number.  In some cases they may hyperfunction, causing, in this way, disorder in the concentration of calcium and other trace elements in the blood.

The hyperfunction of the parathyroid glands may be due to their hypertrophy or a tumor, adenoma of one or more parathyroid glands (primary hyperparathyroidism).  Also, it may happen due to severe renal deficiency (secondary hyperparathyroidism), of even due to hereditary hormone syndromes.

Patients with primary hyperparathyroidism may appear asymptomatic or present some ambiguous symptoms, like weakness, easy fatigue or psychological disorders.  In some advanced cases, we have symptoms from the bones or abdominal pain.  In patients with secondary hyperparathyroidism symptoms of chronic renal deficiency are prominent and in these cases there should be cooperation with the attendant nephrologists.

The diagnosis is done by the endocrinologist.  After taking the history of the patient and the clinical examination, he/she will subject the patient to haematological tests for the measurement of PTH, calcium and other trace levels in the blood.  Then a good ultrasound study should be made. This can detect a hypertrophic parathyroid or an adenoma of the parathyroid and help in the case surgical removal is needed.

Another examination which the endocrinologist will ask for is the scintigram.   This will show the swollen parathyroid glands, and this will help the surgeon in a potential surgical removal.

The treatment of the adenoma and the hypertrophy of the parathyroid glands is surgical removal.  The operation is relatively simple, as long as there has been a correct study for the identification of the pathological parathyroid glands via the ultrasound and the scintigram.  Before the operation is complete, the doctor will ask for frozen section of the gland or glands which were removed, in order to verify that they are pathological.  The patient may be hospitalized for one more day, in order to receive intravenous therapy, as the calcium in the blood may fall to dangerous levels after the removal of the pathological parathyroid glands.  In the long run, the remaining parathyroid glands will recover and the calcium will return to its normal levels.

If, before the operation, sufficient pathology of the thyroid has also been detected, the removal of the thyroid is suggested at the same time.  If removal of the thyroid is required later, the symphyses which will have been created after the first operation for the removal of the parathyroid glands will make the operation of the thyroid much harder