Parathyroid disease treatment depends on the specific type of disorder affecting the parathyroid glands, which are small glands in the neck responsible for regulating calcium levels in the body. The main categories of parathyroid disease include primary hyperparathyroidism, secondary and tertiary hyperparathyroidism, hypoparathyroidism, and very rarely, parathyroid carcinoma (cancer). Each condition requires a tailored approach to restore balance and prevent complications.
For **primary hyperparathyroidism**, where one or more parathyroid glands become overactive producing too much parathyroid hormone (PTH), surgery is generally considered the most effective treatment. The preferred surgical method today is called *minimally invasive parathyroidectomy* (MIP). This procedure involves making a small incision in the neck to remove only the abnormal gland(s) identified through imaging studies. MIP offers high success rates—over 95% cure—and patients often experience rapid relief from symptoms such as fatigue, bone pain, mental fogginess, and muscle weakness shortly after surgery. In some cases where multiple glands are involved or imaging is inconclusive, a more extensive bilateral neck exploration may be performed to examine all four glands[1][2][4][5].
If surgery is not an option due to other health issues or patient preference in primary hyperparathyroidism cases with mild symptoms or borderline calcium levels, medical management can be used. Medications like *Cinacalcet* help lower blood calcium by mimicking calcium’s effect on receptors that regulate PTH secretion. Additionally, close monitoring of calcium levels and bone density may be recommended until surgery becomes necessary[7].
In **secondary hyperparathyroidism**, which usually occurs due to chronic kidney disease causing low calcium levels that stimulate excessive PTH production as compensation, treatment focuses on addressing underlying causes first. This includes managing kidney function carefully along with dietary changes like limiting phosphate intake and supplementing vitamin D analogs to improve calcium absorption. When medical therapy fails or severe gland enlargement develops (tertiary hyperparthyroidism), surgical removal of part or all of the affected glands might be required[1].
**Hypoparathyroidism** represents another category where there is insufficient PTH production leading to low blood calcium levels causing muscle cramps/spasms (tetany), seizures, fatigue and cognitive difficulties if untreated. Since this condition results from underactive or damaged parathyroids often after thyroid/parathryoid surgery or autoimmune causes, lifelong management with oral *calcium supplements* combined with active forms of vitamin D helps maintain normal blood calcium concentrations. In some cases recombinant human PTH injections are prescribed for better control when supplements alone do not suffice[1].
A very rare but serious form called **parathyroid carcinoma** involves cancerous growths within these glands causing extremely high blood calcium that leads to severe symptoms including weight loss and persistent nausea alongside typical signs seen in benign diseases like fatigue and bone pain. Treatment always starts with surgical removal of cancerous tissue aiming for complete excision since this malignancy can recur locally if incompletely removed; additional therapies such as radiation or chemotherapy might follow depending on tumor spread status[1][6]. Due to its rarity specialized centers provide multidisciplinary care including oncologists experienced in endocrine cancers.
Surgical techniques have advanced significantly over time making procedures safer with quicker recovery times while minimizing risks such as damage to nearby nerves controlling voice quality or swallowing muscles.[3][4] Surgeons use intraoperative hormone monitoring during operations—measuring PTH before and after gland removal—to confirm successful excision immediately during surgery.
Post-treatment care varies based on intervention type:
– After successful minimally invasive surgery for primary hyperparthyroidism patients typically see normalization of their blood chemistry within days.
– Those treated medically require regular follow-up labs every few months.
– Hypoparathryoidism patients need lifelong supplementation adherence plus periodic evaluation.
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