Understanding Primary Hyperparathyroidism

~ By Dr Ritesh Aagrwal, Thyroid, Endocrine, Breast & Cancer Surgeon at SL Raheja Hospital – A Fortis Network Hospital ~

~ Witnessed in almost 1/1000 people across the world, but more than 99% remain undiagnosed in India ~

Hyperparathyroidism is an excess of Parathyroid Hormone (PTH) in the bloodstream due to over activity of one or more of the body’s four Parathyroid glands. These glands are about the size of a grain of rice and are located in your neck. Surgery is the most advisable treatment for Primary Hyperparathyroidism (disease where excess PTH hormone is produced). This disease is seen in almost 1/1000 people throughout the world, but unfortunate part is that more than 99% remain undiagnosed in India. Only 1% of patients get treatment and that too after much delay in diagnosis. Females have higher tendency to get this disease.


Usually, there are 4 Parathyroid Glands in our body, they are tiny and are all located in neck. Primary Hyperparathyroidism (PHPT) is a disease in which one or more parathyroid glands produce
excess parathyroid hormone (PTH). This PTH hormone has major function in form of dissolving the bones and releasing calcium from bones. When functioning normally, calcium balance is maintained easily. But when there is excess of PTH, excess calcium is released from bones and in turn, bones become weak and Osteoporotic. Also, the high calcium from the blood may go to the Kidneys and cause Kidney stones, or may go to the pancreas and cause pancreatitis. It may go to the stomach and cause production of more acid leading to hyperacidity which is a very common feature, or may cause many psychiatric problems too. Hence, it is a rule that any patient with Kidney stones should get blood calcium and PTH tested so that the cause of stone formation is diagnosed correctly and treated accordingly.

Shrilata, a 35yr old housewife was suffering from acidity for the past 10yrs and had 3 attacks of Acute Pancreatitis in the past 5yrs. She was also suffering from body pain for many years. However, she remained undiagnosed. When her calcium was checked, it was found to be higher than normal and search started for the cause of this high calcium. It was found to be over function of parathyroid glands. Parathyroidectomy was conducted and her body pain vanished on the same day and acidity issues resolved completely and she had no further attacks of Pancreatitis.

Ganesh, a 42yr old software engineer, had been suffering from recurrent kidney stones for the past 7yrs. Sometimes he had severe pain in the abdomen and had been operated thrice for stones, but the cause of kidney stones remained undetected. Hence he was referred to an Endocrinologist, when his Calcium work-up was done, they found high blood calcium and high blood PTH levels. Further tests revealed that he had a parathyroid adenoma, which was operated and removed. Now, after 4 years of his parathyroid surgery, Ganesh is living a healthy life and no recurrence of kidney stones.

Unless the diagnosis is confirmed, surgery cannot be performed. If only one gland is enlarged, then minimally invasive surgery can be done in any form of Minimally Invasive Parathyroidectomy. However, if more than one gland is found hyperactive, then all four glands need to be checked in order to ascertain which glands have to be removed. Parathyroid surgery is a very
specialized kind of surgery and only an expert Parathyroid surgeon (Endocrine Surgeon) can perform justice to the patient. Because it’s only an expert parathyroid surgeon who can find such tiny glands during operation as many times these parathyroid tumors are very small and may be just a rice grain size.

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