Parathyroid disease is a group of conditions involving the parathyroid glands. There are both benign (not cancerous) and malignant (cancerous) types of parathyroid disease.
The parathyroid glands make parathyroid hormone (PTH), which controls the levels of calcium and phosphorous in the blood.
PTH helps maintain bone health, reduces the risk of kidney stones and preserves kidney function.
Parathyroid gland anatomy
There are four parathyroid glands, all located in the neck near the thyroid. Each gland is typically about the size of a kernel of corn.
Usually, one parathyroid gland is located near each corner of the thyroid. Some people are missing a parathyroid gland or have an extra one. Others have parathyroid glands in unusual locations in the neck or chest, but these glands can still work normally.
Parathyroid disease types
Parathyroid disease occurs when a parathyroid gland makes too much or too little PTH, or when a parathyroid cell mutates and becomes cancerous. The types of parathyroid disease are:
Hyperparathyroidism
Hyperparathyroidism means the parathyroid glands are making too much PTH. In most cases, it is caused by an adenoma, which is a benign tumor, on one gland. This causes the gland to produce too much PTH. In about 20% of patients, all four glands are enlarged and producing too much PTH. Too much PTH may cause elevated levels of calcium in the blood, which is called hypercalcemia. This can result in serious problems, including osteoporosis (weakening of the bones) and kidney stones.
Parathyroid cancer
Cancer of the parathyroid glands is extremely rare. Sometimes, parathyroid cancer causes hyperparathyroidism. However, less than 1% of people with hyperparathyroidism have parathyroid cancer. Men and women have the same risk for parathyroid cancer, which usually strikes people in their 50s.
Although parathyroid cancer progresses slowly, it often comes back after treatment. The cancer returns at the original site in in the neck. The average time before return is about two and a half years.
Hypoparathyroidism
Hypoparathyroidism means the body does not make enough PTH and the calcium level in the blood is too low. This is rare and most commonly occurs after surgery for another condition, such as thyroid surgery.
Parathyroid disease risk factors
A risk factor is anything that increases your chances of developing a particular disease. The risk factors for parathyroid disease include:
- Age and gender: Women over age 50 are at an increased risk of developing hyperparathyroidism.
- Having certain inherited disorders can increase your risk of developing parathyroid cancer. These include familial isolated hyperparathyroidism (FIHP) and multiple endocrine neoplasia.
Some cases of parathyroid disease can be passed down from one generation to the next. Genetic counseling may be right for you. Learn more about the risk to you and your family on our genetic testing page.
Learn more about parathyroid disease:
Learn more about clinical trials for parathyroid disease.
The parathyroid gland is made up of four small glands behind the thyroid gland. Usually, one parathyroid gland is located near each corner of the thyroid. (Click to enlarge.)
Medullary thyroid cancer survivor trusts MD Anderson for long-term care
In March 2019, Dana Reeves was preparing for several milestones. Her daughter was getting ready to graduate from high school. Her husband was about to retire from the military. And her family was preparing to move from Germany back to the United States.
Something she hadn¡¯t planned for? A medullary thyroid cancer diagnosis. But at age 46, that¡¯s exactly what she faced.
Bloodwork leads to medullary thyroid cancer diagnosis
In 2006, Dana was diagnosed with sarcoidosis, an inflammatory disease in which groups of cells form tiny growths, called granulomas, in different organs in the body.
¡°It was built into our military orders that I had to be checked yearly for sarcoidosis,¡± she says. ¡°After I received a great checkup from my doctor, I asked for bloodwork to provide to my civilian doctor since we were about to retire from the military.¡±
The bloodwork revealed something odd in Dana¡¯s parathyroid gland. She was referred to an endocrinologist in Germany, who performed an ultrasound.
¡°Once he started the ultrasound, he said, ¡®You have a lump on the right side of your thyroid, and I¡¯m pretty sure it¡¯s cancer,¡¯¡± she recalls. ¡°I was shocked.¡±
Dana had a biopsy the next day. Pathology reports confirmed that she had stage III medullary thyroid cancer.?
¡°I wanted to see my daughter graduate, and I didn¡¯t want her to have a memory of her mom suffering with cancer,¡± says Dana. ¡°My husband and I grabbed each other¡¯s hands. We didn¡¯t crumble. We didn¡¯t fall apart. We just relied on what we¡¯d always had ¨C our faith.¡±??
Surgery to treat medullary thyroid cancer
After receiving her diagnosis, Dana was referred to an ear, nose and throat specialist in Germany. The doctor did not feel comfortable treating the advanced cancer and recommended a thyroid cancer surgeon in Florida.
So, Dana was transported by a military medical airlift to Florida on April 22 and had surgery the next day.
¡°My calcitonin levels were at 2,200 ¨C up from 1,200 a month earlier. That¡¯s how fast the cancer was growing,¡± she says. ¡°By that point, it should have spread everywhere. But my surgeon discovered that it was just located in my right thyroid.¡±
Dana had a total thyroidectomy with a central neck dissection. The surgeon removed Dana¡¯s entire thyroid as well as 17 lymph nodes. They all came back clear.
Returning to the U.S. and receiving specialized care at MD Anderson
Dana had returned to Germany when her surgeon called with the news that all the cancer was gone.
¡°I asked him, ¡®Where do I go from here?¡¯ I told him I was moving back to Texas, and I¡¯d never received any specialty care other than for sarcoidosis,¡± she says. ¡°Without hesitating, he said I should see at MD Anderson. My life had been in his hands, and he¡¯d treated me so well that I trusted what my surgeon said. So, I said, ¡®I¡¯m going to MD Anderson.¡¯¡±
But not before seeing her daughter graduate high school and celebrating her husband¡¯s retirement from 24 years in the military.
In July, Dana¡¯s family moved back to Texas, settling near the Dallas/Fort Worth area. It was centrally located to her daughter¡¯s college, her parents¡¯ home and MD Anderson.
¡°MD Anderson knows what they¡¯re doing. You get in and do your bloodwork and scans and see the doctor all in the same day,¡± says Dana, who now only comes once a year for checkups. ¡°Dr. Hu, her nurses and the entire crew at MD Anderson have been phenomenal. The nurses make you feel like you¡¯re their only patient. They answer all of my questions.¡±
MD Anderson helps manage treatment side effects
Because Dana no longer has a thyroid, she takes an oral synthetic thyroid hormone called levothyroxine daily. When her levels are off, sometimes she experiences fatigue or a change in mood.
¡°When that happens, I just log into MD Anderson¡¯s portal and tell them that I think my levels are off,¡± says Dana. ¡°They¡¯ll send me a lab slip through , then I¡¯ll visit a local lab and my results are sent to MD Anderson. My care team will tweak my dosage as needed.¡±
Dana¡¯s also dealt with both weight loss and weight gain since her surgery and gone into early menopause.
¡°I literally went into surgery at my goal weight and came home 10 pounds heavier,¡± she says. ¡°I¡¯ve probably gained 30 pounds in this journey of back and forth and up and down. It¡¯s frustrating, but I will take a little bit of weight gain over having cancer any day.¡±
Embarking on survivorship
Dana is thankful for the care she has received at MD Anderson.
¡°Even though I have a family doctor locally, I run everything by Dr. Hu,¡± she says. ¡°I value and trust her opinion.¡±
Dana¡¯s most recent checkup was in February. She was with her husband, and Hu¡¯s nurse practitioner Rebekah Puls was going over the results.
¡°I remember telling my husband that I think it had been five years since my diagnosis and wondered at what point do they cut you loose,¡± says Dana.
Moments later, Hu entered the room and shared some wonderful news.
¡°Dr. Hu said, ¡®Mrs. Reeves, your levels for five years have not only been stable, they¡¯ve also been undetectable. I wanted to let you know that we¡¯re going to move you from cancer patient to cancer survivor,¡¯¡± recalls Dana. ¡°My husband and I started bawling. So was Rebekah. And when I shared with Dr. Hu that when I was first diagnosed, my wish was to see my daughter graduate high school, she started crying.¡±??
Dana was presented with her survivorship certificate, and Hu explained what it meant and what Dana¡¯s care might look like going forward. She is excited about transitioning to survivorship.
¡°I¡¯m happy to share my experience because now that I¡¯m on the other side of it, I can give somebody hope and reassurance that they can get through this,¡± she says. ¡°MD Anderson is the standard. Put yourself in their hands, and they will walk with you through every stage.¡±
or call 1-877-632-6789.?
Why choose MD Anderson for parathyroid disease treatment?
MD Anderson's Endocrine Center brings together some of the nation's top authorities to treat and diagnose benign (not cancerous) and malignant (cancerous) parathyroid disease.
Parathyroid disease is a rare condition. Our program is one of the few in the nation that specializes in all forms of parathyroid disease. This means we have a level of experience and expertise that help improve your outlook for successful treatment.
Your care is customized by a team of experts from many disciplines, including surgery, medical endocrinology, medical oncology and pathology, as well as a specially trained support staff. They communicate and collaborate closely with each other and with you to ensure the most effective, coordinated care.
We also are constantly researching new and better ways to fight parathyroid disease. This allows us to offer clinical trials of new treatments that might not be available elsewhere.
And at MD Anderson you'll also be surrounded by the strength of one of the nation's largest and most experienced cancer centers. From support groups to counseling to integrative medicine care, we have all the services needed to treat not just the disease, but the whole person.
How we¡¯re improving parathyroid cancer care
Until recently, decades passed with little progress in improving the survival rates of parathyroid cancer patients. But our specialized, multidisciplinary team led by ., and , is bringing parathyroid cancer patients new hope.
We sat down with them to understand this rare disease and how MD Anderson is advancing parathyroid cancer treatment. Here¡¯s what they shared.
What is a parathyroid?
We all have four parathyroids located in our necks. These endocrine glands are only the size of a sunflower seed, but they control the body¡¯s calcium by producing a regulatory hormone.
When a parathyroid becomes overactive and produces too much of this hormone, it¡¯s called hyperparathyroidism. The most common endocrine disorder, hyperparathyroidism can result in tumor growth in the neck. Most parathyroid tumors are benign, but some patients have a genetic mutation that leads to the development of parathyroid cancer.
If hyperparathyroidism progresses to cancer, it¡¯s important that it¡¯s caught and treated early, when treatment is most effective. That¡¯s why it¡¯s so important for patients with hyperparathyroidism to be monitored by skilled specialists, such as by our team.
What are common parathyroid cancer symptoms?
When monitoring hyperparathyroidism, we¡¯re suspicious that it¡¯s progressed to cancer if the patient¡¯s calcium and parathyroid hormone levels are high. We¡¯re also concerned if diagnostic imaging, such as a CT scan, ultrasound or a specialized sestamibi parathyroid scan, shows unusual features of the parathyroid gland, such as the glands appearing bigger than normal or calcified. In this case, we also check for a lump on the patient¡¯s neck. In addition, we closely monitor patients who have a family history of kidney tumors or jaw tumors since they can be at higher risk, as well as carriers of the MEN1, CDC73 and P53 gene mutations.
Patients may notice bodily changes, such as excessive urination, excessive thirst, fatigue and bone pain. If you experience these symptoms, seek care from an experienced team to ensure an accurate diagnosis.
Why is an accurate diagnosis so important for parathyroid cancer patients?
A correct diagnosis is necessary to develop an effective treatment plan.
Because parathyroid cancer is so rare, pathologists are often unfamiliar with the disease when making a diagnosis. Your care team should be able to make a diagnosis by evaluating your diagnostic imaging, calcium levels and parathyroid hormone levels.
If you don¡¯t feel comfortable with the choices laid out by your care team or feel they don¡¯t have enough experience treating parathyroid cancer, get a second opinion. It may save your life.
Why is parathyroid cancer difficult to treat?
Malignant parathyroid tumors are often misdiagnosed as benign and treated improperly. Surgery is currently the gold standard for treating malignant parathyroid cancer. It¡¯s best to completely remove the tumor during the initial surgery, so it¡¯s important that your medical team have a suspicion of parathyroid cancer beforehand. Sometimes, the cancer returns when most but not all of the tumor is removed because cancer cells remain in the body. There¡¯s then a higher risk of death due to complications associated with recurrence.
How common is a parathyroid cancer recurrence?
Most people with parathyroid cancer have a recurrence -- either in the same area of initial diagnosis or because the cancer spreads. Unfortunately, recurrence can be fatal. When the tumor comes back locally, it can be difficult to surgically remove because it often attaches to other vital structures like the esophagus, the breathing tube or the major blood vessels in the neck. Some then spread to the lungs, bones or liver. If the surgeon can¡¯t remove all of the parathyroid tumor, the patient¡¯s calcium levels won¡¯t be regulated. The patient may then develop hypercalcemia, which can lead to fatigue, dehydration, increased infection and harm to the kidneys. Although we can relieve pain and discomfort with palliative care, the patient¡¯s unregulated, high calcium levels eventually lead to death.
What parathyroid cancer research is underway?
We¡¯re learning more about parathyroid cancer with six protocols that are currently enrolling patients. Two protocols are examining parathyroid tissue and hoping to predict recurrence through tumor staining. A third study is reviewing diagnostic imaging to more effectively diagnose parathyroid cancer. Fourth, we¡¯re exploring immunotherapy as a treatment option. Fifth, with precision medicine, we¡¯re evaluating molecular profiles of parathyroid tumors and sequencing patients¡¯ genes to identify drugs that may specifically target the mutations. Lastly, we¡¯re studying how circulating tumor cells can help us better monitor parathyroid cancer patients to better predict if a patient¡¯s tumor will recur and, for those who need treatment, how the tumor will respond. By learning more about this disease, we hope to develop newer, better parathyroid cancer treatment options.
Anything else you¡¯d like to share?
Without our patients, none of our new research would be possible. Because of patients like you who are reading this, we¡¯re able to find new treatments. So thank you.
or by calling 1-877-632-6789.
