Hyperparathyroidism (overactive parathyroid)
Constantly tired and listless | Unrecognized parathyroid gland | Symptoms | Therapy | Counselling
Hyperparathyroidism is the overactive function of one or more parathyroid glands. The four parathyroid glands are about the size of a lentil and are attached to the thyroid capsule. They are adjacent to the thyroid gland but have a completely different function, serving to regulate the balance of calcium in the blood. Problems arise if the parathyroid glands carry out their task too well. The parathyroid glands can then develop into independent hormone generators (parathyroid adenoma) and the body becomes flooded with parathyroid hormone (PTH). When PTH is released into the blood by the glands, the concentration of calcium in the blood increases as a result. Excessively high levels lead to a complex of symptoms that is often associated with severe fatigue, depression and reduced functioning. Muscle pain is also typical. This is very limiting and does not respond well to anti-inflammatory drugs.
The symptoms decrease after surgical removal of the parathyroid gland (parathyroidectomy) which was producing excess hormones. Patients often feel more energetic and fatigue decreases. They frequently describe a feeling of having had a heavy weight removed from their shoulders after the surgery. Chronic damage to the kidneys, blood vessels and bones is resolved when calcium metabolism returns to normal. Parathyroidectomies are regularly carried out using endoscopic assistance and a minimally invasive approach. The incision can be limited to a maximum of 2 cm and after a few months is hardly visible.
A highly specialized surgeon is required for successful parathyroid surgery. After resection of a parathyroid adenoma, normalization of the PTH/calcium metabolism is assessed by collection of intraoperative blood samples and communicated to the surgical team in the operating theatre. In simple terms, the operation is successful if the PTH value drops by more than 50% after removal.
The Pyramid Clinic provides the surgeon with another valuable tool for monitoring the success of parathyroid surgery. With intraoperative fluorescence imaging using an infrared camera, overactive parathyroid tissue can be better distinguished from normal parathyroid tissue. This avoids a situation where the parathyroid tissue that is independently producing excess hormones remains in the body, which can lead to a recurrence of the disease.Surgeon Georg Wille describes the minor operation on her parathyroid gland to patient Susanne Schneider. Photo: Samuel Schalch
Susanne Schneider had suffered from unexplained moodiness for almost ten years. The now 57-year-old inhabitant of Zurich was constantly lethargic, tired and irritable. It placed a burden not only on her, but also on her family. “And yet I didn’t feel ill enough to go to bed. It was simply as though a switch had been turned off”, she recalls. When you are over 50, everything is blamed on the menopause anyway, she says. However, the symptoms got progressively worse and suggested depression.
When subsequently she was receiving drug treatment for the onset of osteoporosis, a blood test revealed that something was not quite right with her hormones. Suspicion rapidly fell on the thyroid gland, but this proved to be mistaken. Finally, a specialist discovered the true cause: The problem was the parathyroid gland. This consists of four glands about the size of a lentil that lie behind the thyroid. The parathyroid gland regulates the calcium in the blood, an important building material for the bones. The far larger thyroid gland itself is located beneath the larynx and chiefly produces hormones for the energy balance, which are also known as activating hormones and regulate many metabolic processes in the body.
About 90,000 people, or about one percent of the population of Switzerland, suffer from a disorder of the thyroid or parathyroid gland, predominantly women over the age of 40. Thyroid gland disorders are the second most common metabolic disorder after diabetes. Because the symptoms such as fatigue and lethargy are very general and develop only gradually, it often takes a long while for a diagnosis to be made.
“I have a lot more energy again today than I had before the treatment” says Susanne Schneider.
“The incidence of parathyroid disorders in postmenopausal women in particular is underestimated,” says Jan Krützfeldt, a hormone specialist at the University Hospital of Zurich. The origin is a benign tumour on the parathyroid gland which produces the hormone that causes calcium levels in the blood to rise. As calcium is withdrawn from the bone for this purpose, parathyroid disorders are accompanied by the threat of osteoporosis. Persistent excessive calcium levels in the blood in turn damage blood vessels and organs such as the kidneys. Added to this are general symptoms such as depressive moods and digestive disorders.
“Localizing the tumour is difficult because of its size of just under a centimetre,” says Georg Wille, a specialist in thyroid and parathyroid surgery at the Pyramid Clinic at the Lake in Zurich. He was also the surgeon who ultimately operated on Susanne Schneider. In mild cases of parathyroid disorders, drug treatment is usually sufficient. Mostly, however, as in Susanne Schneider’s case, surgical removal of the tumour is the only way of permanently eliminating the cause of the suffering. According to surgeon Georg Wille, the operation is usually a minor, low-risk procedure: it requires just a two-centimetre-long incision that is no longer visible after a few months. In most cases calcium levels in the blood then rapidly return to normal and the symptoms regress. The costs of surgery are covered by the medical insurance company.
Susanne Schneider underwent this operation about six months ago. Today she is happy. “It didn’t get better overnight, but rather gradually. Now, however, have a lot more energy again,” says the working mother of two.
Similar symptoms to those of the parathyroid glands can also be caused by the actual thyroid gland. Again, it is women who are predominantly affected. A disorder of the thyroid gland can become apparent when the energy balance is disturbed: an excess of activating hormones in the case of an overactive thyroid result in overstimulation of the energy balance, causing sweating, nervousness, increased eating (while still losing weight) and frequently diarrhoea.
In the case of the less common hypothyroidism, the opposite occurs: “As with hibernation in animals, there is a decline in the performance curve, the energy requirement of the cells decreases and you feel frozen and tired,” explains hormone specialist Jan Krützfeldt.
Thyroid disorders and parathyroid problems usually develop slowly over months or years and the body adapts to them. “The symptoms are therefore difficult to detect,” says Krützfeldt. On the other hand, reliable laboratory tests can definitively exclude – or conversely confirm – a suspicion. There is, however, no fear of uncertainty or even of confusion over the diagnosis.
The causes of such disorders have not been precisely established to date. “Having said that, the thyroid gland is closely monitored by the immune system, possibly more so than other organs,” the hormone expert points out. This control could rapidly overshoot at some point and then either inhibit or stimulate the thyroid gland. Jan Krützfeldt does not observe any increase in diseases, but he remarks: “Improved and more frequent laboratory tests yield more diagnoses.”
A thyroid disorder should be treated as soon as possible to prevent permanent damage. In the case of an underactive thyroid, hormone replacement is available. This therapy has no side effects as long as it is given at the right dosage.
Hyperactivity is more difficult to treat: if it is due to inflammation, the inflammation should be inhibited if possible. This involves the use of a drug that suppresses hormone production and at the same time calms the immune system until in most cases a cure of the inflammation is obtained.
If a thyroid nodule, known as a goitre, is the cause of overproduction, this too can be controlled by drugs. However, long-term therapy requires the “goitre” to be either removed surgically or switched off by radioactive iodine.
There is a particular need for research in the treatment of hyperthyroidism. Obliteration of the thyroid nodule by ultrasound or heat may play a more significant role in the future. However, there is still a lack of studies on the longer-term benefit of these methods.
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