One of the most perplexing aspects of parathyroid disease is that the patient is often unaware the disease is present. Parathyroid disease symptoms include tiredness and lethargy, difficulty concentrating, and what patients describe as just not “feeling like themselves.” Some patients experience feelings of malaise and generalized weakness or ‘brain fog’. Most people with parathyroid disease do not even realize that they have it.
The disease is often diagnosed after a primary care physician performs routine laboratory tests that indicate there may be an abnormality of the parathyroid gland hormones. One indicator is elevated calcium levels in the blood. In patients who are not hospitalized, elevated calcium levels generally indicate the need for further evaluation for hyperparathyroidism. The primary care physician generally refers the patient to an endocrinologist for further work-up and evaluation. If the biochemical tests performed confirm that the patient has parathyroid disease, the patient is referred to a surgeon for surgical removal of the parathyroid. Medical treatment is not ideal for parathyroid symptoms.
Parathyroid Symptoms
Symptoms generally include the following: fatigue, tiredness and malaise. Joint pain, bone pain, lack of concentration and even personality changes are also typical symptoms. Patients commonly report muscle weakness and state that they are not quite as strong as they used to be, but they will oftentimes blame this on their age. Some patients will describe having difficulties getting out of a chair as a result of their proximal muscle weakness.
Some patients have a history of kidney stones, blood in their urine, or a recent history of bone fractures. Other symptoms include frequent urination and urination at night.
Hyperparathyroidism can be genetic. There is definitely a familial association with primary hyperparathyroidism, and it can be experienced in tandem with something called multiple endocrine neoplasias, a constellation of endocrine problems. If you have multiple family members who have had issues with primary hyperparathyroidism, then you certainly want to let your doctor know so that this can be investigated and evaluated.
Parathyroid Diagnosis
Before recommending you see the surgeon, your endocrinologist will usually reconfirm your labs in his/her office. Oftentimes, he or she will ask you to collect your urine for 24 hours then evaluate the calcium content. If you have not done this, you will want to prior to your evaluation with Dr. Duperier. Please bring the information recorded for the 24-hour collection to your initial surgical evaluation. Additionally, your endocrinologist should order a bone density scan prior to your surgical consult. This test must have been completed within the 12-month period prior to your surgical evaluation. The bone density scan is important because the parathyroid gland produces a hormone called parathyroid hormone. The hormone is then circulated and picked up by the bones. It leeches the calcium out of the bones, thus making them weaker. The calcium leeched from your bones and circulated is collected and filtered out by the kidneys, and therefore, patients develop kidney stones. Because of the bone weakening, you should definitely plan on having a bone density scan at least once a year after your parathyroid surgery.
The good thing about having surgery for primary hyperparathyroidism is that you can expect your bone density to increase. Yearly bone density scans will demonstrate the improvement of your bone density and validate your decision to pursue surgery. Likewise, kidney stones can be resolved and cured as a result of having your parathyroid surgery!
Parathyroid surgery
Parathyroid surgery typically lasts for anywhere between 30-60 minutes. There are instances, however, where it could take several hours. The incision is generally about 2″-3″ in length, and the risks of parathyroid surgery are low. There is a less than 1 percent chance of injury to an important nerve called the recurrent laryngeal nerve, the nerve responsible for your voice. There is also a less than 1 percent chance that all four parathyroid glands will be injured. Bleeding occurs in <1% of surgeries.
Parathyroid Recovery
After surgery, patients should plan on spending one night in the hospital. However, many times they will be able to go home the same day, following a routine visit to the recovery room. Patients are walking, talking, eating and drinking the night of their surgery. After surgery, there are no significant restrictions on you. We ask that you not drive a car for a couple of days because your neck is likely to be somewhat sore. Most patients are discharged and do not require the use of narcotics for pain. After surgery, you will follow up with your endocrinologist, as well as with Dr. Duperier. The appointment with your surgeon is usually within the first two to three weeks after surgery. During that time, most patients feel significantly better. Many patients report that, retrospectively, they feel like they were living in a “haze” before surgery and usually say they feel much sharper, more attentive and energetic post-surgery.
After surgery, an overwhelming number of patients are cured, and most require no significant follow-up, other than one appointment with the parathyroid surgeon. If everything is resolved and your calcium remains normal after surgery, your progress will be followed by the endocrinologist and your primary care physician.