Parathyroid Disease Treatment in Sydney

Parathyroid disease, most commonly primary hyperparathyroidism, occurs when one or more of the four parathyroid glands produces excessive parathyroid hormone (PTH), leading to elevated blood calcium levels. This can cause kidney stones, bone loss, fatigue, depression and muscle weakness. Parathyroidectomy is the definitive cure, with success rates exceeding 95 percent in experienced hands.

What Is Hyperparathyroidism?

The parathyroid glands are four tiny glands, each roughly the size of a grain of rice, situated behind the thyroid gland in the neck. Despite their name, they have no functional relationship to the thyroid: they are entirely separate endocrine organs that regulate calcium balance by producing parathyroid hormone (PTH).

Hyperparathyroidism is classified into three types:

Primary hyperparathyroidism: the most common form, caused by a benign parathyroid adenoma (single gland enlargement) in approximately 85 percent of cases, multigland hyperplasia in 10 to 15 percent, or rarely parathyroid carcinoma (less than 1 percent). The gland autonomously overproduces PTH regardless of calcium levels.
Secondary hyperparathyroidism: a compensatory response to chronically low calcium, most commonly seen in chronic kidney disease or severe vitamin D deficiency. All four glands enlarge.
Tertiary hyperparathyroidism: occurs when secondary hyperparathyroidism becomes autonomous, typically after prolonged kidney disease. The glands continue overproducing PTH even after the underlying cause is corrected.

Symptoms of Parathyroid Disease

The classic teaching summarises hyperparathyroidism symptoms as "bones, stones, abdominal groans and psychic moans." Many patients present with vague, non-specific symptoms that have been present for years before diagnosis:

Bones: bone pain, osteoporosis, increased fracture risk
Stones: kidney stones (calcium-containing), recurrent urinary tract symptoms
Abdominal groans: nausea, constipation, abdominal pain, loss of appetite
Psychic moans: fatigue, depression, difficulty concentrating, memory problems, irritability, anxiety, insomnia
Excessive thirst and frequent urination
Muscle weakness, particularly in the legs
Joint aches

Many patients with primary hyperparathyroidism are initially asymptomatic, with the condition discovered incidentally on routine blood tests showing elevated calcium. However, studies show that even these "asymptomatic" patients often have subtle symptoms that improve significantly after surgery.

Causes and Risk Factors

Age: primary hyperparathyroidism is most common in people over 50
Sex: women are affected two to three times more often than men, particularly post-menopausal women
Radiation exposure: previous head and neck radiation increases risk of parathyroid adenoma
Lithium therapy: long-term lithium use (for bipolar disorder) increases the risk of hyperparathyroidism
Genetic syndromes: multiple endocrine neoplasia types 1 and 2A (MEN1 and MEN2A) and familial isolated hyperparathyroidism
Vitamin D deficiency: severe, prolonged deficiency can trigger secondary hyperparathyroidism
Chronic kidney disease: the most common cause of secondary hyperparathyroidism

Diagnosis

At Central Sydney ENT, parathyroid disease is diagnosed through:

Blood tests: The hallmark of primary hyperparathyroidism is elevated serum calcium with an inappropriately elevated or non-suppressed PTH level. Additional tests include phosphate (typically low), vitamin D, renal function and 24-hour urine calcium to exclude familial hypocalciuric hypercalcaemia (a benign condition that mimics hyperparathyroidism).

Sestamibi-SPECT/CT scan: A nuclear medicine scan using technetium-99m sestamibi, which is preferentially taken up by overactive parathyroid tissue. Combined with CT (SPECT/CT), this provides precise anatomical localisation of the abnormal gland, enabling minimally invasive surgery.

Neck ultrasound: High-resolution ultrasound can identify enlarged parathyroid glands and is used in combination with sestamibi scanning for concordant localisation, increasing accuracy.

4D CT scan: In cases where sestamibi and ultrasound are discordant or non-localising, 4D CT provides detailed perfusion imaging that can identify abnormal parathyroid glands with high sensitivity.

DEXA scan: Bone density assessment to determine whether hyperparathyroidism has caused osteoporosis, which is one of the established indications for surgery.

Treatment Options

Parathyroidectomy

Surgery is the only curative treatment for primary hyperparathyroidism and is recommended for all symptomatic patients and for asymptomatic patients who meet established surgical criteria (calcium level more than 0.25 mmol/L above normal, osteoporosis, kidney stones, reduced kidney function, or age under 50).

When pre-operative imaging has localised a single abnormal gland, minimally invasive focused parathyroidectomy is performed through a small 2-3 centimetre incision. The abnormal gland is removed and intraoperative PTH measurement confirms successful cure (PTH should drop by more than 50 percent within 10-15 minutes of gland removal). Cure rates exceed 95 percent.

Our head and neck surgeons: including Dr Alexander Zhang and Dr Rahuram Sivasubramaniam: perform parathyroid surgery with intraoperative PTH monitoring across Central Sydney ENT locations.

Medical Management

For patients who are not surgical candidates, medical management may include adequate hydration, cinacalcet (a calcimimetic that reduces PTH secretion and calcium levels), bisphosphonates for bone protection, and monitoring of calcium, kidney function and bone density. However, medical therapy does not cure the disease and requires lifelong treatment.

When to See an ENT Specialist

You should seek a referral to an ENT or head and neck specialist if:

Blood tests have shown elevated calcium and PTH levels
You have been diagnosed with primary hyperparathyroidism by your endocrinologist or GP
You have recurrent kidney stones and elevated calcium
You have osteoporosis with elevated PTH
You have unexplained fatigue, depression or bone pain with elevated calcium

Related Conditions

Parathyroid disease is closely linked to several other conditions treated at Central Sydney ENT:

Thyroid Nodules: thyroid and parathyroid conditions may coexist and be assessed together
Thyroid Cancer: parathyroid preservation is a key consideration during thyroid cancer surgery
Salivary Gland Stones: hypercalcaemia from hyperparathyroidism can increase the risk of salivary stones

Common Questions

Parathyroid Disease FAQ

What are the parathyroid glands and what do they do? +

The parathyroid glands are four tiny glands (each about the size of a grain of rice) located behind the thyroid gland in the neck. They produce parathyroid hormone (PTH), which regulates calcium levels in the blood. Calcium is essential for bone health, muscle function, nerve signalling and heart rhythm. When PTH is overproduced, blood calcium rises to abnormal levels.

What is the difference between thyroid and parathyroid disease? +

Despite their similar names and close anatomical location, the thyroid and parathyroid glands are entirely separate organs with different functions. The thyroid produces hormones that regulate metabolism, while the parathyroids regulate calcium balance. Parathyroid disease causes high calcium levels and its associated symptoms, not the metabolic symptoms seen in thyroid disease.

Is parathyroid surgery a major operation? +

Modern parathyroid surgery is typically a minimally invasive procedure performed through a small (2 to 3 centimetre) incision in the neck under general anaesthesia. When pre-operative imaging has localised the abnormal gland, focused or targeted parathyroidectomy can be performed in approximately one hour as a day case, with most patients going home the same day and returning to normal activities within a few days.

What happens if hyperparathyroidism is not treated? +

Untreated hyperparathyroidism causes progressive bone loss (osteoporosis) increasing fracture risk, recurrent kidney stones, kidney damage, cardiovascular complications, and worsening fatigue, depression and cognitive impairment. Early surgical treatment prevents these complications and most patients report significant improvement in energy levels and overall wellbeing after parathyroidectomy.

Does Central Sydney ENT perform parathyroid surgery? +

Yes. Central Sydney ENT has fellowship-trained head and neck surgeons experienced in parathyroid surgery. We work closely with endocrinologists and offer comprehensive parathyroid assessment and surgery across seven Sydney locations including Burwood, Campbelltown, Gregory Hills, Ultimo, Drummoyne, Hunters Hill and Miranda.