The thyroid and the parathyroid glands are not related in terms of what they do. The prefix “para” means “next to”; since the parathyroid glands were discovered long after the thyroid and their function was not clear at the time, they were named para-thyroid. They do not have the same function or purpose.

Parathyroid glands are part of the endocrine system, which is the hormonal system in the body. This means they control other parts of the body with the chemical they produce called hormones. The purpose of the parathyroid glands is to regulate the calcium level in our bodies within a very narrow range so that all cells in the body can function properly. Every cell in the body uses calcium as a part of its daily workings. The glands measure the amount of calcium in the blood. If the blood serum calcium levels decrease, the glands will recognize it promptly and release additional parathyroid hormone. When the calcium in the blood is high enough again, the parathyroids slow down and stop making parathyroid hormone. The parathyroid hormone or PTH goes to other parts of the body, mainly the bones and kidneys and instructs them to take actions to increase the calcium in the blood.

Most people have four parathyroid glands, which sit behind or just adjacent to the thyroid. They can actually be hidden within the thyroid gland. Parathyroid glands form at the base of the tongue in the developing baby. Typically the glands migrate down into their expected positions. But the final position of the parathyroid glands can be found anywhere from the base of the tongue, down through the neck, and even into the upper part of the chest.

We, generally, have four parathyroid glands. The most common manner in which the parathyroid glands become a problem, is when they make too much parathyroid hormone or PTH. This is known as hyperparathyroid disease or hyperparathyroidism. Blood tests drawn for routine annual physical exams or in preparation for other medical procedures may show an abnormal elevated serum calcium level. Hence most patients , in today’s world, have no symptoms whatsoever. But the elevated serum calcium level prompts the physician to request a serum PTH level from which the diagnose of hyperparathyroidism is made.

The four parathyroid glands have a very rich blood supply, used to monitor the calcium level in the blood 24 hours a day. On the surface of the parathyroid cells, there is a sensor that acts like a thermostat for calcium levels in the blood. This sensor is called the calcium sensing receptor. As the blood filters through the parathyroid gland, these receptors detect the level of calcium, and react by adjusting the levels as needed, adding or making less parathyroid hormone.

Hyperparathyroidism may occur in two different presentations. In the first, the patient will have three normal parathyroid glands the size of a small pea, and one parathyroid tumor that is much larger, perhaps as big as an olive or a grape. The single over-active parathyroid is known as a parathyroid adenoma. It will make too much parathyroid hormone, causing a potentially serious calcium imbalance.

Alternatively, all 4 glands may be relatively normal in size, but significantly overactive. This is known as 4 gland parathyroid hyperplasia.

Finally, when the serum calcium is truly excessive, with levels in the 12-to 14 range or higher, this may indicate a malignant condition. Parathyroid cancer is treatable by surgery.

Surgery

Surgery is not the only way to treat parathyroid disease (hyperparathyroidism). However, surgical excision is the only method available to cure hyperparathyroidism. There are a few medications available to treat parathyroid problems or high calcium. However, these are usually reserved for very ill patients with significant co-morbid conditions who are not good candidates for surgery under general anesthesia.

With the exception of those exceptionally ill patients who are deemed to sick for surgery, the therapy for hyperparathyroidism is to undergo excisional parathyroid surgery.

Surgical Experience

The parathyroid glands often look exactly like the surrounding fatty tissue in the neck. Chose an experienced surgeon. There are subtleties to finding, identifying and removing parathyroid glands. Only a surgeon with significant parathyroid surgical experience is likely to possess these diagnostic and therapeutic surgical skills.