Condition Overview
Parathyroid hyperplasia is the enlargement of all four parathyroid glands, leading to excessive production of parathyroid hormone (PTH) and causing hyperparathyroidism. This condition elevates calcium levels in the blood (hypercalcemia) or results in increased PTH with normal calcium levels, leading to symptoms like fatigue, kidney stones, muscle weakness, bone pain, and osteoporosis. Unlike a parathyroid adenoma, which typically affects a single gland, parathyroid hyperplasia involves all glands. It can be associated with genetic syndromes, such as Multiple Endocrine Neoplasia (MEN), or arise due to long-term kidney disease. Diagnosis is confirmed with elevated PTH levels, often paired with high calcium. Imaging can be less fruitful if multiple glands are enlarged because normal parathyroid glands are usually not seen with most imaging tests. Because of that, minimally invasive techniques can be less advantageous. Paradoxically, if a patient has involvement of multiple parathyroid glands, their labs can suggest more mild hyperparathyroidism.
Treatment Options
Minimally Invasive Parathyroidectomy (MIP)
Description: This technique involves the removal of enlarged parathyroid glands through small incisions, using advanced imaging and focused techniques. MIP allows for quicker recovery and less visible scarring compared to traditional surgery. It is ideal for cases where one or two glands are affected, but it may be less well suited for parathyroid hyperplasia.
Indications: patients preferring a minimally invasive option, or when pre-operative imaging clearly identifies the affected glands. Again, this is less likely to be the case if a patient has hyperplasia.
Parathyroid Surgery
Description: Traditional parathyroid surgery for hyperplasia involves removing three or more of the overactive parathyroid glands. In cases of hyperplasia, this is the most common treatment approach to normalize PTH and calcium levels, preventing the complications of hypercalcemia. Depending on the patient's condition, a subtotal parathyroidectomy (leaving a portion of one gland) is the standard approach. Very rarely, a total parathyroidectomy with autotransplantation (reimplanting some parathyroid tissue) may be considered as a treatment option (usually just for patients with secondary hyperparathyroidism).
Indications: Patients with diffuse parathyroid hyperplasia and no localized parathyroid gland, symptomatic hyperparathyroidism, or symptoms like kidney stones and bone loss.
"Scarless" Parathyroidectomy
Description: This is an endoscopic approach where the parathyroid glands are removed through small incisions inside the lower lip, leaving no visible scar on the neck. This technique offers a cosmetic advantage while effectively treating hyperparathyroidism.
Indications: Patients with well-localized parathyroid glands who are motivated to avoid cervical scars and prefer a cosmetically superior option. This should be carefully discussed with your surgeon before selecting this option if you are thought to have hyperplasia.
Management of parathyroid hyperplasia requires a multidisciplinary team of endocrinologists, surgeons, and radiologists. Early intervention is key to preventing serious complications such as severe bone loss. Post-surgery, regular monitoring ensures long-term success and helps detect any recurrence. An experienced team, like that at the Russell Center, provides comprehensive care and access to advanced surgical options for managing parathyroid hyperplasia.
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