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Do you have kidney stones? Make sure you get your parathyroid hormone, known as PTH, tested. It often turns out that kidney stones are the result of an overactive parathyroid gland! This disease, still often overlooked by doctors, can also cause osteoporosis, stomach ulcers, and even hypertension.
The parathyroid glands are tiny (no larger than a pea) endocrine glands, arranged symmetrically behind the thyroid gland. Most often there are four, but there are people who have only one parathyroid gland and some who have as many as eight; it also happens that they do not lie at all behind the thyroid gland, but inside it, and even in the thymus or abdominal cavity. Their job is to regulate the levels of calcium and phosphorus in the body. An overactive parathyroid gland can prevent the kidneys, bones, eyes and nervous system from working properly.
Hyperparathyroidism and hypercalcemia and hypocalcaemia
With the so-called primary hyperparathyroidism, or PNP for short, there is too much parathyroid hormone (PTH) in the body, responsible for maintaining normal levels of calcium in the body. Excess PTH actually always means hypercalcemia, i.e. excess calcium in the blood – with the simultaneous release of calcium from the bones, which very quickly ends in their decalcification. PTH also stimulates the synthesis of vitamin D3 in the kidneys, which in turn enhances the absorption of calcium in the intestines, further increasing hypercalcemia. Renal reabsorption of calcium is also enhanced. This is why problems with PTH levels most often affect the kidneys, bones and the digestive system.
There are also times when dependency works the other way around: it is not an overactive parathyroid gland that causes kidney problems, but vice versa. Chronic renal failure causes the so-called secondary hyperparathyroidism. Sick kidneys cannot cope with the synthesis of vitamin D3 and do not fully excrete phosphates that accumulate in the body. Insoluble calcium phosphate is formed, causing a reduction in the level of ionized calcium from the circulation. As a result, hypocalcemia occurs, i.e. too low calcium concentration in the blood – and the body reacts to it by overproducing parathyroid hormone. And, just like with primary hyperthyroidism, health problems that can affect various organs.
Symptoms of excess parathyroid hormone
Primary hyperparathyroidism can have a wide variety of symptoms; and hence the difficulties in diagnosing it. The most common symptom is nephrolithiasis, which returns regularly and affects both kidneys. It can lead to the degeneration of the renal parenchyma and their failure. Urolithiasis is found in over 60% of patients with PNP.
Another serious disease caused by excess parathyroid hormone is osteoporosis. A characteristic symptom is especially the so-called subperiosteal resorption; on x-rays, the edges of the bones in the fingers of the hand appear gnawed. There are also cysts in the bones, i.e. cavities that make bones break easily, even with minor falls and blows. Doctors sometimes act routinely and give patients calcium, in increasing doses, to strengthen the bones, or offer patients (the disease most often affects women aged 35-50), hormone replacement therapy, including protect the bones – however, a PTH level test should be ordered then.
PTH also stimulates the secretion of gastrin, a hormone that, inter alia, increases the production of hydrochloric acid in the stomach. Effect? Peptic ulcer of the stomach and duodenum, resistant even to strong and otherwise very effective drugs. With an excess of PTH, pancreatic proenzymes are also activated, which increases the risk of pancreatitis and the appearance of stones in the pancreas.
That’s not all. Side effects of excess PTH in the body are also depressive states, apathy, disorientation, migraines, itching of the skin, joint pain, visual disturbances suggesting cataracts, left ventricular hypertrophy and heart rhythm disturbances, especially bradycardia, i.e. a condition when the heart beats too slowly ( less than 50 times per minute). In patients with PNP, a tumor of the gums, called epilepsy, is also more common than in others.
Diagnosis of primary hyperparathyroidism
“In the US, where I’ve been working for eleven years, hyperparathyroidism is usually diagnosed fairly early,” says the drug. med. Alicja Golding, endocrinologist. – Parathyroid hormone levels are tested almost routinely in people who have broken bones, even if they are only 25 years old, and have broken down on skis. Those who complain of irritability that are difficult to explain, and above all, of course, those who have any problems with the kidneys, are also sent for examination. Urolithiasis or increased urine output are reasons for an immediate PTH and calcium level test.
In Poland, unfortunately, the diagnosis is usually made too late, when the kidneys are already failing. Patients with hyperparathyroidism usually first see a urologist who deals with nephrolithiasis, but often does not test the level of parathyroid hormone. He heals them for years, telling them, for example, to drink Jan or Zuber mineral water or beer to stimulate their kidneys to work. Sends you to smash stones. And he does not commission this simple study, which privately costs PLN 30-40.
This state of affairs is confirmed by Krzysztof Tupikowski, Grażyna Bednarek-Tupikowska and Romuald Zdrojowy from the Medical Academy in Wrocław, in their article on parathyroid glands published in Urologia Polska: destruction of kidneys and / or bones. Clinical symptoms of PNP concern one or several systems simultaneously: urinary, bone, digestive, muscular, articular, cardiovascular, central nervous system and eyes ”.
Surgery for parathyroid adenoma
The cause of primary hyperparathyroidism (PNP for short) is in more than 80% of cases an adenoma of one of the parathyroid glands. Many patients break down when they hear such a diagnosis, but it is not a malignant tumor! Parathyroid cancer is responsible only for 0,5-3,5% of PNP cases, although of course, the tissues collected during surgery are always examined just in case. And surgery is by far the most effective, and actually the only, currently recommended way to deal with PNP. Many doctors recommend surgery even in those patients who have not yet developed symptoms such as bone decalcification or kidney stones.
“These symptoms appear sooner or later for the vast majority of people,” says Dr. Golding. “So instead of risking and examining the patient every now and then from head to toe, including the heart and eyes, it is better to put him in the hospital for four days and just remove the small gland.”
Before the operation, it is of course necessary to find out exactly where the adenoma is located – while the tactile examination can only diagnose every 10th case. So an ultrasound is done; but even this is often not enough, as well as an MRI or CT scan. In most cases, the best is parathyroid scintigraphy, which is a computerized scan using isotopes; their dose is completely safe for the body. The benefits of surgery are visible almost immediately: in more than 70% of patients whose PNP was manifested by nephrolithiasis, the stones disappear after removal of the affected parathyroid gland. Usually, mental problems, stomach ulcers and bone changes gradually disappear, and the cysts calcify. Hypertension, even if it has developed over many years, decreases and bradycardia completely resolves.
In patients with secondary hyperthyroidism, the most important is the treatment of nephrolithiasis, dialysis of a patient with renal failure, or – in severe cases – even transplantation. Once the kidney problems have resolved, PTH levels usually return to normal.
Tetany after parathyroid surgery
Many patients fear parathyroid surgery for fear of hyperthyroidism and the accompanying tetany, i.e. very painful muscle contractions. In fact, the condition occurs in some patients for days or weeks after surgery. Doctors even talk about the hungry bone syndrome – after the procedure, there is an intense deposition of calcium in the bones, especially if cysts have already formed in them. Bones capture almost all available calcium, and suddenly there is no hypercalcemia but hypocalcemia, i.e. calcium deficiency.
However, if, from the first hours after the surgery, the patient receives adequate doses of calcium, magnesium and vitamin D3, and regularly (for the first 2-3 months, even weekly), the blood is checked and consulted with a doctor, tetany does not have to be achieved!