Dr Dennis T H Lim
Head and Neck General SurgeonMBBS, M.Med (Surg), FRCS (Edin), FRCS (Glas), FAMS
The parathyroid glands are four tiny, pea-sized glands located behind the thyroid in the neck. Despite their small size, they play a vital role in regulating calcium levels in the blood by producing parathyroid hormone (PTH).
When these glands become enlarged and produce excessive PTH, it leads to a condition known as hyperparathyroidism. The most common type, primary hyperparathyroidism, usually occurs due to a benign tumour (adenoma) on one of the glands. In contrast, secondary hyperparathyroidism develops as a response to low calcium levels or vitamin D deficiency, often linked to chronic kidney disease.
Parathyroid surgery (parathyroidectomy) is often recommended when high calcium levels or overactive glands cause symptoms, complications or pose significant health risks. This procedure helps restore balance and protect long-term health.
Your doctor may recommend removing one or more overactive or abnormal parathyroid glands for these reasons:
A normal blood calcium level ranges from 8.5 to 10.5 mg/dL. When the blood calcium level consistently exceeds the normal range, it is often an indicator of parathyroid disease, which causes dehydration, frequent urination and confusion. Over time, hypercalcaemia may damage organs like the kidneys and heart.
Many individuals typically report feeling unusually tired, which persists throughout the day and does not improve with rest. This fatigue may also be accompanied by muscle weakness and difficulty concentrating or memory problems (often described as brain fog), making routine activities feel more challenging than usual.
Excess PTH causes the body to pull calcium from the bones, weakening its skeletal structure over time. This leads to osteoporosis, which makes bones fragile and prone to fractures even with minor injuries. Individuals may also experience unexplained bone pain, particularly in the back, hips or wrists, as bone density decreases.
Prolonged exposure to high calcium levels can damage the kidneys over time. The kidneys tend to work harder to filter excess calcium from the blood, potentially leading to chronic kidney disease. High calcium levels may also crystallise and form kidney stones, causing recurrent episodes of severe flank pain, blood in the urine or changes in urination patterns.
Hyperparathyroidism can impact the gastrointestinal system, leading to symptoms such as nausea and vomiting in the morning or after meals. High PTH levels can slow down digestive processes, which makes bowel movements less frequent and more difficult. Some patients may report abdominal pain, ranging from mild discomfort to severe cramping.
High calcium and PTH levels can affect the brain, leading to mood changes such as depression, anxiety or irritability. Sleep disturbances are also common, with many individuals reporting difficulty falling asleep, frequent awakening and non-restorative sleeping patterns. These sleep disturbances can worsen fatigue and cognitive symptoms during the day.
There are several medical conditions related to the parathyroid glands that may necessitate surgery, including:
This condition occurs when one or more parathyroid glands become overactive, often due to a benign adenoma. It is the most common reason for parathyroid surgery and requires intervention if symptoms or complications arise.
A parathyroid adenoma is a benign growth on one of the parathyroid glands that causes excessive PTH production. They vary in size but typically measure between 1 and 3 cm. Despite being benign, these tumours can cause significant health problems if left untreated.
MEN syndrome is a group of genetic disorders affecting multiple endocrine glands, including the parathyroids. It often leads to the development of tumours in various glands, necessitating careful monitoring and potential surgical intervention to prevent complications.
Parathyroid carcinoma typically presents with severe hypercalcaemia and markedly elevated PTH levels. A hard, fixed mass in the neck may be noticeable during physical examination. While it represents less than 1% of all hyperparathyroidism cases, this condition requires aggressive surgical management to prevent the spread of cancerous cells.
Deciding whether an individual is a suitable candidate for parathyroid surgery involves a thorough evaluation of symptoms and overall health. These tests help doctors assess parathyroid function and identify abnormalities:
During your surgical consultation, the doctor will review your medical history, symptoms and test results in detail. Additional pre-operative testing may be done to optimise your safety during surgery. For patients with other health conditions, coordination with specialists such as anesthesiologists may be required.
Do not wait for symptoms to worsen or complications to develop. If you suspect you might have parathyroid problems based on symptoms or test results, schedule a consultation today to discuss your treatment options and determine whether parathyroid surgery is appropriate for your situation.
Head and Neck General SurgeonMBBS, M.Med (Surg), FRCS (Edin), FRCS (Glas), FAMS
Dr Dennis T H Lim is a specialist in head and neck surgical oncology, with expertise in cancers of the thyroid, parotid gland, head and neck, and melanoma. Trained at the Memorial Sloan-Kettering Cancer Center, New York, Dr Lim previously served as Senior Consultant Surgical Oncologist at the National Cancer Centre and Singapore General Hospital. He now runs a private practice, providing personalised, multidisciplinary care using advanced surgical techniques to optimise outcomes for patients with head and neck cancers.
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