The parathyroid glands don’t get a lot of attention. Most people are more familiar with their well-known neighbor, the thyroid gland. The parathyroid and thyroid glands, though, have different independent roles that are equally important.
The grain-of-rice-sized parathyroid glands secret an eponymous substance called parathyroid hormone (PTH). When there’s a problem with the parathyroid gland that causes PTH levels to get off kilter, it can lead to a cascade of complex problems.
In primary hyperparathyroidism, the parathyroid glands are overactive, producing and secreting too much PTH. Endocrinologists— physicians who specialize in the organs of the endocrine system, including the parathyroid gland—have found that primary hyperparathyroidism is usually linked to a benign tumor on one or more of the glands.
The good news is that if that if the tumor is surgically removed (when clinically warranted), the medical fallout often reverses itself over the following several months. The bad news is that the diagnosis of primary hyperparathyroidism is notoriously missed by primary care physicians and providers.
What are the signs and symptoms of primary hyperparathyroidism?
Many people with hyperparathyroidism don’t even know they have it. It’s often picked up on blood work that ordered as part of the basic metabolic panel. Patients with primary hyperparathyroidism will have high calcium levels on their blood work.
Other symptoms include fatigue, depression, memory problems, abdominal pain, pain in other body parts, and constipation.
When left untreated, hyperparathyroidism can cause painful and dangerous complications including kidney stones, hypertension (high blood pressure), osteopenia or osteoporosis (thin bones), and bizarre or unexplained broken bones.
Although a person of any sex or age can develop hyperparathyroidism, it’s more common among women and people over 60 years old.
What happens in hyperparathyroidism?
When a patient has primary hyperparathyroidism, high levels of PTH cause a derangement of Vitamin D levels and the calcium balance in the body. This can lead to depletion of calcium from the bones and increase the risk of bone fractures unrelated to trauma.
Additionally, when left untreated for years, secondary effects of hypertension can cause permanent cardiac damage.
It’s not unusual for primary care physicians, physician assistants, and nurse practitioners to misdiagnose primary hyperparathyroidism even when the telltale sign of elevated blood calcium levels is right in front of them. When the rest of a patient’s blood work is normal, or consistent with the patient’s baseline, some doctors and providers will take a “wait and see” approach for elevated blood calcium. This violates the standard of care.
According to endocrinology and surgical experts, the standard of care requires ordering follow-up testing in the situation. First, repeat blood work to look at the calcium levels can rule out the possibility of a laboratory error. If the elevated calcium levels are verified, then additional blood work to look at Vitamin D and parathyroid hormone (PTH) levels should be ordered.
The failure to do a complete workup of a patient who has high blood calcium levels can lead to years of delayed diagnosis and treatment of patients who receive regular primary care.
What’s the treatment?
Although the symptoms of primary hyperparathyroidism may be treated with drugs to regulate calcium levels, there is a growing consensus that surgery is often indicated.
Most surgeons will order a nuclear medicine study called a sestamibi parathyroid scan, which allows the surgeon to locate the affected area and use a minimally invasive approach. This procedure involves injecting a radioactive agent called technetium 99, which is absorbed by the overactive parathyroid gland, allowing it to be picked up by a gamma camera placed over the patient’s neck.
The surgery itself involves a small incision in the neck following to explore the four parathyroid glands and remove any of them that have a tumor (almost always a benign adenoma).
Because of the short half-life of PTH, hormone levels return to normal within a matter of minutes after the tumor is removed. This in turn, quickly affects calcium resorption by the bones. That’s why surgeons should require patients to take oral calcium pills immediately following the surgery and for the following several months.
If you’ve experienced severe long-term health effects caused by a delayed diagnosis and treatment of hyperparathyroidism in Texas, then contact a top-rated, experienced Houston, Texas medical malpractice lawyer to discuss your potential case.