When a parathyroid gland becomes hyperactive, disrupting the body’s calcium balance, a disease known as hyperparathyroidism  occurs. Overactive parathyroid glands can affect calcium levels and cause fatigue, bone pain, mood changes, and many other symptoms.

Symptoms tend to develop slowly, and may be mild or nonexistent, so many people don’t realize something is wrong. They may have symptoms for long periods of time before they get a correct diagnosis and treatment. The most common treatment is parathyroid surgery, which eliminates the hyperactive tissue.

Understanding hyperparathyroidism and the parathyroid glands

There are typically four parathyroid glands in the human body, and they’re often described as being the size of a grain of rice or a pea. They are embedded into the back of the thyroid lobes in the neck, typically two on each side.

When a person is in good health, their parathyroid gland secretes parathyroid hormone (PTH), which regulates blood and bone calcium levels. Calcium is an important mineral for the heart, muscles, nerves, bones, and teeth.

What is hyperparathyroidism?

Hyperparathyroidism starts when one or more enlarged or overactive gland, or glands, makes too much PTH and raises calcium levels. There are three main forms  of this condition:

• Primary hyperparathyroidism. One or more of the glands begins releasing too much PTH, usually because of a parathyroid adenoma (benign tumor) or all the glands become enlarged (hyperplasia).
• Secondary hyperparathyroidism. Another medical condition, often kidney disease, causes consistently low levels of calcium and vitamin D in the blood. In turn, the parathyroid overproduces PTH.
• Tertiary hyperparathyroidism. Long-term calcium imbalance from chronic kidney disease or similar issues triggers the parathyroid to overproduce PTH.

Why symptoms are often missed or attributed to other causes

The symptoms  of hyperparathyroidism are often so subtle and mild that they’re difficult to spot. They range from vague discomfort to more noticeable changes like:

• Frequent urination
• Constant thirst
• Easy fatigue
• General weakness
• Bone or joint pain
• Stomach pain
• Nausea or low appetite
• Constipation
• Itchy skin
• Depression
• Poor concentration

It’s easy to confuse certain symptoms with age-related changes or other health issues. A diagnosis  typically occurs through routine blood tests, bone density evaluations, urine tests, X-rays, ultrasounds, or CT scans.

Long-term health consequences if untreated

Without treatment, the symptoms of hyperparathyroidism will get worse . The excess production of PTH eventually breaks down the bones and releases calcium into the blood, which can cause hypercalcemia and other disorders:

• Bones become weak, making them much easier to break.
• Early bone loss that can lead to osteoporosis.
• Kidney stones. Excess calcium causes painful crystals to form inside the kidneys.
• Cardiovascular disease. High calcium levels increase blood pressure risks.

How is a diagnosis of hyperparathyroidism made?

Most people find out they have hyperparathyroidism when they go in for routine bloodwork or an unrelated health concern. Their results show high levels of calcium, which prompts the doctor to perform other tests to confirm the diagnosis.

• Bone mineral density test
• Urine test
• Imaging tests

Imaging and localization studies

When you get a diagnosis of hyperparathyroidism  that requires surgery, the doctor will order parathyroid imaging tests. These scans help the surgeon locate the exact parathyroid glands contributing to your symptoms.

• Sestamibi scan. Uses a radioactive tracer that highlights overactive parathyroid tissue.
• Thyroid ultrasound. Uses high-frequency sound waves to create real-time gland images.
• 4D CT scan. Uses layered CT imaging with timed contrast for clearer localization.

Why surgery is the most common treatment

Parathyroidectomy is an effective treatment  for hyperparathyroidism, with a success rate of over 95%. Recurrence of hyperparathyroidism occurs in fewer than 2% of patients who get the surgery.

Due to its effectiveness in removing the hyperactive glands, surgery is the go-to method for treating primary hyperparathyroidism. While some patients may need immediate surgical intervention, others may be able to manage their condition with “watchful waiting,” in which they undergo routine testing to track their bone density, renal function, and calcium levels. However, surgery is the safest and most permanent way to stop the disorder from progressing for those who meet certain criteria.

How parathyroidectomy works

Hyperparathyroidism surgery is a minimally invasive procedure in most cases. A focused parathyroid surgery is the standard approach when preoperative imaging clearly shows a single overactive gland.

When imaging shows multiple glands are enlarged or overactive, you may need a bilateral neck exploration. The surgeon can place the incision in a natural crease on your neck to make the scar less noticeable. This technique is also helpful when the initial side explored doesn’t reveal the overactive gland.

Once you’re brought into the operating area, the head and neck surgeon or endocrine surgeon will:

• Give you anesthesia so you don’t feel any pain.
• Make a small incision on the neck or mouth to reach the glands.
• Remove the overactive gland or glands.
• Close the incision with stitches.

The procedure generally lasts about 1-2 hours.

Parathyroid surgery recovery

Most people experience mild discomfort during the first few days after a minimally invasive parathyroidectomy  but have a quick recovery overall. Your scar should fade away, especially if you follow your surgeon’s incision-care instructions.

Most people return to their normal activities within a few days and enjoy a full recovery within one to three weeks. Since vigorous exercise can strain the healing tissues, it’s important to get clearance from your surgeon before you resume working out.

Hyperparathyroidism surgery is not a completely risk-free procedure. Some patients do experience side effects:

• Postoperative hypocalcemia. A temporary drop in calcium levels while the remaining glands heal. You may experience cramping or tingling. These effects typically go away within a few weeks. The doctor may prescribe calcium supplements to stabilize your levels during recovery.
• Hungry bone syndrome. Bones rapidly absorb calcium after surgery, causing long-term deficiency. Treatment focuses on supplements to build up the necessary minerals and vitamins. This condition may be reversed in days or months, but in some cases can last for up to a year.
• Voice changes. Mild hoarseness can occur from nerve irritation during the healing process. Any voice changes are usually mild and temporary.

Outcomes  from successful hyperparathyroidism surgery

Some people’s calcium levels return to normal within days after hyperparathyroidism surgery. In others, it can take a few weeks for their levels to stabilize. As the hormone and calcium balance starts to level out, you should notice improvements in energy, mood, and bone discomfort.

Beyond early healing, many patients experience significant long-term improvements:

• Improved bone density. Bone mass increases steadily for years following successful parathyroid surgery.
• Reduced fracture risk. Lower likelihood of future bone breaks, especially hip fractures.
• Improved kidney stone risk. Stone episodes drop sharply and continue decreasing over several years.
• Improved quality of life. Many patients report better vitality and emotional well-being post-surgery.
• Possible reduction in cardiovascular risk. Some studies show decreased long-term heart risks, though evidence varies.
• Improved cognitive function in the elderly. Older adults often experience clearer thinking and better mental function.

Finding the right hyperparathyroid surgeon

When you get a diagnosis that requires surgery, it’s imperative to do a search for “an experienced thyroid/parathyroud surgeon near me.” High-volume parathyroid surgeons complete more than 50 thyroid/parathyroid surgeries each year. They bring years of experience and surgical mastery to the procedure that you won’t find with providers who only do a few surgeries a year.

The Otolaryngology, head and neck surgery, and Endocrinology team at Florida Medical Clinic Orlando Health provides access to a skilled team of hormone and gland experts. We can check your calcium and PTH levels to see whether hyperparathyroidism surgery is a viable option for you. If so, we’ll walk you through each step so you know what to expect. If your tests reveal another underlying cause, we’ll direct you to the right specialist for proper treatment.

Schedule a consultation today to learn more about hyperparathyroidism surgery and how to relieve your symptoms.

About Drs. Espinola and Pfaff

Dr. Trina Espinola is a board-certified otolaryngologist and head and neck surgeon. She’s highly trained in the latest medical and surgical techniques for conditions of the ears, nose, throat, head, and neck. She has presented on topics such as thyroid cancer, head and neck cancer management and is experienced at treating thyroid and parathyroid disease. Dr. Espinola is fluent in both English and Spanish, which allows her to give all patients the utmost level of care. Request an appointment with Dr. Espinola by calling (727) 553-7100.

Dr. Julia Pfaff is a board-certified otolaryngologist and head and neck surgeon whose areas of expertise include thyroid and parathyroid disorders, head and neck cancer, and sinus conditions. Having undergone thyroid surgery during her medical training, Dr. Pfaff draws on her personal experience to connect with her patients and provide exceptional care. She is one of the few doctors in Florida qualified to perform the Inspire Implant procedure for sleep apnea. Schedule an appointment with Dr. Pfaff by calling (727) 553-7100.