Information About Parathyroid Disorders
What Are Parathyroid Glands?
The parathyroids are tiny endocrine glands located adjacent to the thyroid in the neck. Everyone has four of them (very rarely 5), and they all do one thing: regulate calcium levels in the blood. They do this by producing parathyroid hormone (PTH). When the calcium in the blood is low, the parathyroid glands make more PTH to bring the calcium back up. When the blood calcium is too high, the parathyroid glands stop making PTH, which will lead to a drop in blood calcium.
Most of the body’s calcium is stored in the bones, but calcium is more than just a component of bones. The brain, nerves and muscles depend on calcium for signaling. The blood needs proper calcium. Surgeons at TGH's Parathyroid & Thyroid Institute are two of only a handful of surgeons in the world who operate solely on the parathyroid glands to treat parathyroid disease. We have some of the highest cure rates with minimal complications and operative times that are a fraction of the time that it takes other surgeons to do this procedure. Recognized as One of the Nation's Best and Highest Ranked Hospital in Florida for Ear, Nose & Throat by U.S. News & World Report 2024-25, TGH is a destination for parathyroid patients from around the world.
Parathyroid Disease
Parathyroid disorders are characterized by abnormal functioning of the parathyroid glands.
Primary Hyperthyroidism
The most common disorder of the parathyroid glands is called primary hyperparathyroidism, which is the overactivity of one or more of the parathyroid glands. This is usually caused by a benign parathyroid tumor, or adenoma, that produces too much parathyroid hormone (PTH). PTH works in several ways to increase the calcium in the bloodstream, called hypercalcemia. This can be seen on routine blood tests, and this is often how patients find out that they have parathyroid disease.
Although parathyroid tumors are almost always benign (non-cancerous), they are not harmless. Untreated parathyroid disease can lead to chronic fatigue, insomnia, memory loss, kidney stones, cardiac arrhythmias (like atrial fibrillation), chronic kidney disease and osteoporosis. The disease significantly impairs quality of life. Fortunately, primary hyperparathyroidism can be cured with a quick outpatient 25 minute procedure that is safe and effective.
Other Parathyroid Disorders
Parathyroid disease can also arise as:
- Benign and Malignant Parathyroid Tumors
A parathyroid tumor can grow in one or more of the parathyroid glands. A parathyroid tumor is almost always benign, meaning it is not cancerous. Rarely these tumors can be malignant and cause cancer. - Secondary Hyperparathyroidism
Secondary hyperparathyroidism is more often referred to as renal hyperparathyroidism (RHPT) and is a complication of kidney disease. Renal hyperparathyroidism occurs when the kidneys malfunction and lose their ability to transform inactive vitamin D to active vitamin D. This disrupts the body’s ability to absorb calcium. Also happens as a result of Dialysis. - Tertiary Hyperparathyroidism
Tertiary hyperparathyroidism occurs when a patient has had longstanding secondary hyperparathyroidism, which makes it difficult for the parathyroid glands to return to their normal functions. As a result, the parathyroid gland continues releasing an excessive amount of PTH into the bloodstream. It happens commonly after renal transplantation. - Normocalcemic Primary Hyperparathyroidism
Normocalcemic primary hyperparathyroidism (nPHPT) is characterized when someone has a blood calcium level in the normal range, but their parathyroid hormone level is too high. It is widely thought that nPHPT is an early form of primary hyperparathyroidism. - Persistent and Recurrent Hyperparathyroidism
Persistent hyperparathyroidism is a condition when calcium levels and PTH have not stabilized within six months of parathyroid treatment.Similarly, recurrent hyperparathyroidism is defined as elevated calcium levels and PTH that returns at least six to 12 months after proper levels had previously been stabilized.
- Hypercalcemia / High Blood Calcium
Hypercalcemia is a condition that occurs when someone’s blood calcium level is above normal. This can cause many complications. - Parathyroid Cancer
Parathyroid cancer occurs when a tumor develops in the tissues of the parathyroid gland. Although these tumors are almost always non-cancerous, there is an extremely rare possibility for tumors to become cancerous. They are very aggressive but almost never seen.
World-Class Treatment for Parathyroid Disorders at the TGH Parathyroid & Thyroid Institute
As a patient at the TGH Parathyroid & Thyroid Institute, you will be evaluated by two of the world’s most experienced specialists in parathyroid disease, Dr. Politz and Dr. Lopez. They have performed more parathyroid operations than any other pair of surgeons in the world over the last twelve years and work as a team on every case. Because our physicians focus exclusively on the surgical treatment of parathyroid disorders, we have in-depth knowledge about all aspects of diagnosing and treating these conditions.
Our two experts evaluate all four parathyroid glands of each patient to ensure no tumor is left behind. With the extreme variability of parathyroid anatomy and appearance, this is of paramount importance and ensures the best outcomes for our patients.
Depending on your unique situation, our physicians will recommend one of several types of parathyroid gland removal surgery, or parathyroidectomy
- Minimally invasive parathyroidectomy (MIRP) – a minimally invasive, radio-guided approach to parathyroid gland removal; most patients leave the hospital within two hours after the procedure
- Reoperative parathyroidectomy – a surgical approach to discover and remove parathyroid glands that may have been missed during a previous surgery
- Combined (Complex) thyroid and parathyroid surgery – a procedure that combines the removal of the parathyroids and thyroid gland
What is Unique About Parathyroid Surgery at Tampa General?
- Our two surgeons (Dr. Politz and Dr. Lopez) have performed more parathyroid operations than any other pair of surgeons in the world over the last ten years, and our surgeons work as a team on every case. Each patient has our two experts evaluate all four parathyroid glands. With the extreme variability of parathyroid anatomy and appearance, this is of paramount importance and ensures the best outcomes for our patients.
- All four parathyroid glands are assessed to make sure no tumor is left behind (up to 30% of patients will have more than one parathyroid tumor, and these generally are not seen on any scans). Many surgeons will only evaluate one parathyroid gland, as finding and evaluating all four glands quickly and safely can be very challenging. Our surgeons have the extensive experience necessary to be able to find and evaluate all four glands on almost all patients despite negative radiographic or nuclear medicine scans.
- The physiologic activity of each parathyroid gland is assessed in real-time to assure hyperfunctioning glands are removed and normal glands are left behind in a healthy state.
- Our center avoids unnecessary and expensive tests that add little to the diagnosis and treatment of parathyroid disease. This includes many of the localization studies that attempt to find the parathyroid tumor preoperatively, including CT scans. Our patients do not need any imaging studies prior to the day of surgery. On the day of surgery, each patient gets a sestamibi scan to ensure that the tumor is not in an unusual location and a thyroid ultrasound to evaluate the thyroid for any suspicious nodules that might change the course of the procedure. These studies may not show the adenoma, but because our surgeons are experienced in finding all four parathyroid glands, it is not necessary to perform any further imaging before the operation.
- Everyone at the center, from the OR technicians who work with the surgeons to the transporters who take patients to the scanner, is dedicated solely to caring for parathyroid patients. They are all part of one team.
