What are they?
These four glands sit in the neck around the thyroid gland and control the level of calcium in the blood.

What can go wrong with the parathyroid glands?
The glands may become overactive leading to too high a level of calcium in the blood. This is called primary hyperparathyroidism.

Why is calcium so important?
Calcium is important for proper functioning of the brain, muscle and nervous tissue and the maintenance of healthy bones. This is why we have parathyroid glands and other systems in the body to maintain the calcium at a normal level.

What are the symptoms of raised calcium?
Some people have no symptoms. Others will experience malaise, muscular aches and pains, abdominal pain or constipation, kidney stones and thirst. These symptoms have often been present for a long time before a diagnosis is reached. There may even be psychiatric type symptoms of mania or depression.

What if I feel perfectly well?
For many patients there are very few symptoms and some will have none. However all will be losing calcium from the bones and developing osteoporosis (thinning of the bones). There is also evidence that there are longterm effects on the heart and major blood vessels.

What causes hyperparathyroidism?
The commonest cause is a benign tumour of a parathyroid gland resulting in excess production of parathyroid hormone. This condition is curable by a simple surgical procedure.

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Patients with primary hyperparathyroidism are at risk of osteoporosis - or thinning of the bones.  This puts patients at high risk of fractures after small falls or even spontaneous fractures e.g., of the spine.

Unfortunately who will develop osteoporosis is very difficult to predict.  The risk of osteoporosis is not related in any way to the levels of calcium or even parathyroid hormone in the blood.  Patients with only very slight elevations of calcium in the blood may well develop osteoporosis.

Studies show that 50% of patients with parathyroid disease will develop osteoporosis if left alone for 10 years.

Treatment with drugs does not affect this.  So drugs such as bisphosphonates (alendronic acid is an example) will not necessarily prevent the bone loss.

This is another reason why early surgery is advisable for many patients particularly those with other risk factors for the development of osteoporosis.

Minimally Invasive Parathyroid Surgery (MIP) or minimal access parathyroid surgery

Mr McLaren offers this new and exciting treatment to suitable patients (80%).

Minimally invasive parathyroid surgery requires the abnormal gland to be identified prior to surgery. This is done with a simple ultrasound scan of the neck and a special scan (Sestamibi scan) which highlights the abnormal gland. Examples of these are shown below:

Minimally invasive parathyroid surgery can be done under local anaesthetic and only requires a 2cm scar considerably smaller than the conventional approach.

Mr McLaren has published his results of this technique in a leading journal run by the British Association of Day Surgery.

For further information please read my comprehensive information sheet:

FHH or Familial Hypocalciuric Hypercalcaemia

This is an interesting topic for anyone with parathyroid disease.

The interest in FHH comes from the fact that it is one of the causes of an elevated calcium level so should be considered by your doctor as part of the differential diagnosis.

The important point about it is that the parathyroid glands are normal... The elevated calcium of FHH does not for reasons that are unclear cause symptoms in the way that a similar level from parathyroid disease would. There is no cure for FHH and the elevated calcium is permanent and not in any way a problem.

If the diagnosis of FHH is missed and you end up having surgery nothing abnormal will found the surgery will achieve precisely nothing.

FHH is excluded by checking a 24 hour urine collection and measuring the amount of calcium excreted in the urine. This is a very important test.

FHH patients have a low level of urine calcium excretion - usually <100mg per 24 hours.

Other hints that this condition is present are:

1. Only mild elevation of calcium which has been stable over time
2. Young age
3. Patients with a family history of 'parathyroid disease'


Nowadays if there is doubt there is a genetic test to exclude FHH however this takes a long time to get done and in my view is generally not necessary.