Ana recently became concerned about persistent fatigue, nausea, constipation, and unexplained bone pain. After several consultations, her doctor mentioned a possible issue involving small, lesser-known glands in the neck: the parathyroid glands. They explained that a dysfunction in these glands, although often silent at first, can significantly impact overall health, particularly kidney and bone health.
But what exactly do the parathyroid glands do? How do their disorders manifest, and how are they identified?
Hello, I’m Dr Joy!
In this article, I’d like to give you a clear overview of these disorders and the symptoms to watch for.
I – The Crucial Role of the Parathyroid Glands
The parathyroid glands are small but vital endocrine organs, usually four in number, about the size of a lentil or a grain. As the name suggests, they’re located close to the thyroid gland. However, despite the similar names and proximity, they have entirely different functions.
The parathyroid glands operate independently and are solely responsible for producing parathyroid hormone (PTH). This hormone plays a key role in regulating calcium and phosphorus levels in the body.
Calcium is essential for bone formation and remodelling, muscle function, heart rhythm, nerve transmission and blood clotting. PTH regulates calcium excretion by the kidneys, promotes its absorption in the gut (with help from vitamin D), and if needed, releases calcium from bones to maintain normal levels.
II – Types of Parathyroid Disorders
The parathyroid glands can become overactive (hyperfunction) or underactive (insufficiency). The most common disorders are linked to overactivity, known as hyperparathyroidism.
Primary hyperparathyroidism usually results from the overfunction of a single gland, producing too much PTH. This leads to high calcium levels in the blood (hypercalcaemia). It occurs mostly in women, especially post-menopause.
Secondary hyperparathyroidism may be linked to vitamin D deficiency, kidney disease, or intestinal malabsorption syndromes (e.g. after bariatric surgery or with coeliac disease). In this case, PTH is elevated, but blood calcium levels may be low or normal.
Hypoparathyroidism refers to insufficient PTH production, leading to low calcium levels (hypocalcaemia).
III – Possible Causes
Primary hyperparathyroidism is most often caused by a benign cellular growth (around 80% of cases), more rarely by malignant tumours or genetic conditions.
Secondary hyperparathyroidism of renal origin is related to kidney dysfunction, while intestinal forms result from poor intake or absorption of calcium and/or vitamin D.
Other possible causes include endocrine disorders, certain medications, supplements and infections.
Hypoparathyroidism often occurs after thyroid surgery, where the parathyroids may have been accidentally removed or their blood supply damaged. It may be temporary or permanent.
IV – Symptoms and Detection of Parathyroid Disorders
Symptoms depend on whether the glands are overactive or underactive. Some parathyroid disorders cause no symptoms and are detected incidentally through routine blood tests showing abnormal calcium levels.
Symptoms of hyperparathyroidism with hypercalcaemia may include:
- Loss of appetite, nausea, vomiting, abdominal pain, constipation
- Fatigue, memory issues, depression, mood changes
- Muscle weakness
- Kidney or gallbladder stones
- Kidney dysfunction, increased urination or thirst
- Bone fragility (osteoporosis), bone pain, increased fracture risk
- Skeletal deformities
- Heart rhythm problems, high blood pressure
- Severe hypercalcaemia: coma or seizures
Symptoms of hypoparathyroidism with hypocalcaemia may include:
- Tingling in fingers, toes, or around the mouth
- Muscle cramps or spasms (usually hands and feet)
- Visual disturbances (rare)
- Brain calcifications (rare)
- Severe hypocalcaemia: seizures or intense spasms (tetany)
V – Diagnosis and Treatment of Parathyroid Disorders
Diagnosis is straightforward through blood tests measuring PTH and calcium levels. Other tests may include phosphorus, magnesium, vitamin D levels, kidney function, and urinary calcium excretion.
Imaging such as neck ultrasound or parathyroid scintigraphy can help visualise gland enlargement. To check for complications, renal ultrasound and bone densitometry may be recommended.
Treatment aims to restore calcium and phosphorus balance. In hyperparathyroidism, options include surgery, medication, and lifestyle changes. In hypoparathyroidism, ongoing calcium and vitamin D supplementation is required. In other cases, the root cause should be addressed.
If you have symptoms that may relate to a parathyroid disorder or a routine blood test revealed abnormal calcium levels, speak to a healthcare professional.
For a specialised evaluation, you can book an appointment at Alegria Medical Centre with our endocrinologist, Dr Sara Pinheiro.
Beijinhos !
Dr Joy
This information is not a substitute for medical advice.
You must seek the advice of your doctor or another qualified health professional with any questions you may have regarding your health condition.
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