PARATHYROID ADENOMA & CANCER

What are Parathyroid Glands?

• Usually 4 small glands

• Located behind the thyroid gland

• Their main job is to keep calcium balance normal

• Calcium is important for:

  • Bones

  • Teeth

  • Muscles

  • Nerves

  • Heart function

3. What Happens in Parathyroid Adenoma?

One gland becomes enlarged and overactive.
It releases excess PTH, which:

• Pulls calcium out of bones

• Increases calcium in blood

• Causes multiple body problems

This condition is called Primary Hyperparathyroidism.

4. What are the Symptoms?

Many patients have no symptoms and it is found on routine blood tests.

When symptoms occur, they are mainly due to high calcium:

Common Complaints:

• Weakness and tiredness

• Bone pain

• Joint pain

• Kidney stones

• Frequent urination

• Constipation

• Abdominal pain

• Depression or mood changes

• Memory problems

Classic Saying:
“Bones, Stones, Groans, and Psychiatric Moans”

• Bones → bone pain, fractures

• Stones → kidney stones

• Groans → abdominal pain, constipation

• Psychiatric → mood changes, confusion

5. How is it Diagnosed?

Blood Tests:

• High Calcium

• High PTH

• Low/Normal Vitamin D sometimes

Urine Test: High calcium in urine.

6. What is Localisation and Why is it Important?

Localisation means finding exactly which parathyroid gland is abnormal before surgery.

Since there are 4 glands, the surgeon must know:

• Which gland is enlarged

• Exact location

• Whether it is in normal position or ectopic (abnormal position)

Good localisation helps:

• Smaller incision

• Shorter surgery

• Less complications

• Faster recovery

• Higher success rate

7. What Tests are Used for Localisation?

Common Imaging Tests:

1. Ultrasound Neck

   • Simple

   • Non-invasive

   • No radiation

2. Sestamibi Scan (Nuclear Scan)

   • Very important test

   • Shows overactive gland clearly

3. CT Scan / 4D CT

   • Used if ultrasound and sestamibi are unclear

4. MRI

   • Rarely needed

Often Ultrasound + Sestamibi together give best results.

8. What is the Treatment?

Definitive Treatment = Surgery (Parathyroidectomy)
Medicines cannot permanently cure adenoma.

9. Who Needs Surgery?

Surgery is advised if:

• Symptoms present

• Very high calcium

• Kidney stones

• Bone weakness/osteoporosis

• Age < 50 years

• High urine calcium

• Reduced kidney function

Even without symptoms, many doctors still advise surgery.

10. What Happens During Surgery?

Parathyroidectomy means removal of the abnormal gland.

Types of Surgery:

1. Minimally Invasive Parathyroid Surgery

• Small cut in neck

• Done when localisation is clear

• Short operation

• Less pain

• Same day or next day discharge

2. Bilateral Neck Exploration

• Larger surgery

• Surgeon checks all 4 glands

• Done if localisation is unclear

11. What is Intraoperative PTH Monitoring?

During surgery, blood PTH level is checked.

• If PTH drops quickly → surgery successful

• Helps confirm correct gland removed

12. What are the Benefits of Surgery?

• Normal calcium levels

• Relief from bone pain

• Prevention of kidney stones

• Improved mood and memory

• Stronger bones

• Better quality of life

Success rate is >95% when localisation is accurate.

13. What are Possible Complications?

Rare but may include:

• Low calcium temporarily

• Voice change (nerve injury – rare)

• Bleeding

• Infection

Most patients recover well.

14. What Happens After Surgery?

• Calcium levels checked

• Temporary calcium tablets may be needed

• Regular follow-up

• Bone strength improves gradually

15. Is Parathyroid Adenoma Cancer?

No.
It is almost always benign. Parathyroid cancer is very rare.

16. Key Take-Home Message

• Parathyroid adenoma causes high calcium

• Localisation is crucial for safe and quick surgery

• Surgery is the only permanent cure

• Outcomes are excellent with proper imaging and experienced surgeon.