The parathyroid glands are four tiny glands, located in the neck, that control the body’s calcium levels. Each gland is about the size of a grain of rice (weighs approximately 30 milligrams and is 3-4 millimeters in diameter). The parathyroids produce a hormone called parathyroid hormone (PTH). PTH raises the blood calcium level by:
- breaking down the bone (where most of the body’s calcium is stored) and causing calcium release
- increasing the body’s ability to absorb calcium from food
- increasing the kidney’s ability to hold on to calcium that would otherwise be lost in the urine.
Normal parathyroid glands work like the thermostat in your home to keep blood calcium levels in a very tightly controlled range. When the blood calcium level is too low, PTH is released to bring the calcium level back up to normal. When the calcium level is normal or gets a little too high, normal parathyroids will stop releasing PTH. Proper calcium balance is crucial to the normal functioning of the heart, nervous system, kidneys, and bones.
Surgical removal, or parathyroidectomy, is the only known cure for primary hyperparathyroidism and is currently the best treatment. In the hands of an experienced endocrine surgeon, success (cure) rates approach 95-98%. Medications such as estrogen and bisphosphonates will NOT cure primary hyperparathyroidism but may decrease calcium or parathyroid hormone (PTH) levels and improve bone density. A new type of medication called calcimimetics (i.e. Sensipar, Cinacalcet) may lower blood calcium levels and PTH levels, but they are not currently approved by the FDA (Food and Drug Administration) for use in primary hyperparathyroidism and will NOT cure the disease. These medications have not been studied to determine whether or not they help decrease effects on other systems in the body or whether they improve the more subjective symptoms of primary hyperparathyroidism (depression, fatigue, muscle aches and pains, difficulty concentrating, memory problems, insomnia, constipation).