Theparathyroid glands(singular in Latin:parathyroid glands) they are multiple smallendocrine glandslocated in the neck. There are usually four of them, but the number of these glands can vary. The parathyroid glands are located on its posterior surfacethyroid gland, usually, lying on its four poles. They areresponsible for the production of parathyroid hormone (PTH), which occurs in response to blood calcium levels and is essential for regulating calcium homeostasis.
Parathyroid Gland Anatomy
People usually have four parathyroid glands, however, some people may have as many as six. The glands are small, flattened, oval in shape. They are located on the posterior surfaces of the right and left lobes of the thyroid gland. The parathyroid glands are yellowish-brown in color.
Each gland is about 6 mm long, 4 mm wide and 2 mm thick and weighs about 30-35 g. There are usually two parathyroid glands on each side. Those placed higher are called the superior parathyroid glands, but the lower ones are called the inferior parathyroid glands.
Its locationsuperior parathyroid glandsis stable. They can be found in the middle of the posterior border of each thyroid lobe, at the level of the lower border of the cricoid cartilage. They are about 1 cm above its entranceinferior thyroid arteryin the thyroid gland. The superior parathyroid glands arise from the fourth pharyngeal pouch.
Unlike the superior glands, theinferior parathyroid glandsmay they have various locations. However, they are usually located near the lower poles of the lobes of the thyroid gland. In some cases, the inferior parathyroid glands may lie all the way downsuperior mediastinum. The inferior parathyroid glands arise from the third pharyngeal pouch.
Parathyroid gland histology
The parathyroid glands are nodular structures consisting of irregular lobes and lobes. The two main types of cells in the parathyroid lobes are theprincipal cellsandoxyphil cells. Other types of cells found in the parathyroid glands include clear cells and fat cells. All these cells are densely packed forming the parenchyma of the parathyroid glands. The layer consists of connective tissue that covers the gland in the form of a capsule and extends into the gland as trabeculae, which partially describe the lobes and lobules.
Principal cells
Chief cells are also known as parathyroid chief cells or simply parathyroid cells. They occupy the most important part of the functional tissue of the parathyroid gland. Despite their considerable number, principal cells are smaller than other cells. The principal cells are polygonal in shape with a round nucleus.
When there is a normal level of calcium in the blood, the principal cells are mostly inactive. Dormant principal cells have a smaller number of secretory granules than active ones. If the level of calcium in the blood is low, the chief cells are activated as they have a calcium-sensing receptor that helps them. In response to a low calcium level, the principal cells secrete parathyroid hormone (PTH).
Oxyphilic cells
Oxyphilic cells are fewer in number but larger in size compared to principal cells. The function of these cells is unclear. They appear only during puberty and increase in number with age. Because of their late appearance, oxyphil cells are thought to originate from principal cells. Oxyphilic cells have many mitochondria, while the endoplasmic reticulum, Golgi apparatus, and secretory granules are poorly developed, in contrast to principal cells.
Parathyroid gland functions
The main The function of the parathyroid glands is the hormonal regulation of calcium and phosphate levels in the blood in a very narrow range. This is important for the nervous and muscular systems to function properly. The parathyroid glands do this by producing parathyroid hormone (PTH).
Parathyroid hormone
Parathyroid hormone is secreted by the chief cells of the parathyroid gland. It is a hormone that regulates calcium and phosphate levels in the blood by affecting the bones, kidneys and gut. PTH secretion is stimulated from the following factors:
- Decreased calcium in the blood
- Mild decrease in blood magnesium
- Increased phosphates in the blood
- Adrenaline
- Histamine
And PTH secretion is suspended by the following:
- Increased calcium in the blood
- Significantly reduced magnesium level
- Calcitriol
- Decreased blood phosphates
As mentioned earlier, PTH is secreted in response to low blood calcium levels. PTH acts on the cells within the bones, causing them to release calcium into the bloodstream, thereby regulating the amount of calcium in the bones and thus affecting bone strength and density.
The hormone stimulates osteoclast activity to release more ionic calcium from the bones into the bloodstream to increase serum calcium levels. Therefore, bones act as a calcium reservoir to maintain normal calcium levels in the body. PTH affects osteoclasts indirectly by binding to osteoblasts.
Another way that PTH can increase calcium levels is by acting on the epithelial cells lining the intestinal tract to increase calcium absorption from the diet. PTH also affects serum phosphate levels by decreasing phosphate reabsorption from the renal proximal tubule, resulting in increased urinary phosphate excretion.
Intestinal absorption of calcium and phosphate is mediated by an increase in activated vitamin D. Calcium absorption is more dependent on vitamin D than phosphate absorption. PTH also upregulates the enzyme responsible for converting vitamin D to its active form.
Neurovascular supply of parathyroid glands
Arterial blood supply
The arterial supply to the parathyroid glands is similar to that ofthyroid gland. The glands are supplied by its branchesinferior thyroid arteries, arising from thesubclavian arteries. They can also be provided with anastomoses between the inferior thyroid andsuperior thyroid arteries, and the thyroid gland.
Venous drainage
The parathyroid glands are drained by thehigher, medium andinferior thyroid veins. The superior and middle thyroid veins drain into theinternal jugular vein, while the inferior thyroid vein drains into brachiocephalic vein. All three thyroid veins arise from the thyroid venous plexus around the thyroid gland.
Lymphatic drainage
Lymph from the parathyroid glands is collected by lymphatic vessels that drain into theparatrachealanddeep cervical lymph nodes.
Neurosis
The endocrine secretion of the parathyroid glands is regulatedhormonally, while the blood vessels of the gland receive rich innervation from the sympathetic nervous system through branches ofnice trunk. That is, they are supplied by branches originating from the thyroid branches of the cervical ganglia. These nerves are vasomotor and not secretomotor.
Disorders of the parathyroid gland
Parathyroid gland disorders can be divided into two groups based on the activity of the parathyroid glands. If the parathyroid glands are overactive, it is known ashyperparathyroidism. On the other hand, if the parathyroid glands are underactive, it is known ashypoparathyroidism.
Hyperparathyroidism
In hyperparathyroidism there is an increase in PTH in the blood because the parathyroid glands are overactive. This raises blood calcium levels, leading to hypercalcemia. Hyperparathyroidism can be primary, secondary or tertiary.Primary hyperparathyroidismcaused by a tumor in the parathyroid gland. It can be a parathyroid adenoma, parathyroid hyperplasia, or parathyroid carcinoma. Surgery to remove the parathyroid gland is usually the first treatment option. Symptoms of primary hyperparathyroidism are associated with hypercalcemia and may include the following:
- Kidney stones
- Constipation, indigestion
- Nausea, vomiting
- Osteoporosis, osteomalacia
- Lethargy, fatigue
- Depression
- Memory loss
- Psychosis, delirium
Secondary hyperparathyroidismusually occurs in response to long-term hypocalcemia. The most common cause of hypocalcemia is chronic renal failure. In rarer cases, the reason may be malabsorption. Most of the symptoms in the case of secondary hyperparathyroidism are related to the underlying disease. People may also experience bone and joint pain, limb deformities. Treatment usually begins with treating the underlying cause.
Tertiary hyperparathyroidismoccurs after prolonged secondary hyperparathyroidism when the parathyroid glands do not respond to serum calcium levels. The symptoms are usually the same as in the case of primary hyperparathyroidism and hypercalcemia. Treatment is based on the underlying cause.
Hypoparathyroidism
Hypoparathyroidism occurs when the parathyroid glands do not function properly and the secretion of PTH decreases, which leads to low serum calcium levels (hypocalcemia). Hypoparathyroidism can be caused by removal of the parathyroid glands during surgery, autoimmune diseases, magnesium deficiency, and hemochromatosis. Signs and symptoms of hypoparathyroidism include the following symptoms of hypocalcemia:
- Paraesthesia
- Fatigue, headaches
- Bone pains
- Insomnia
- Abdominal cramps
- Chvostek's sign (facial muscle contractions with facial nerve stimulation)
- Trousseau's sign (hyperreflexia and tetany after blocking blood flow to the arm using a blood pressure cuff)
Treatment of hypoparathyroidism begins with intravenous calcium as severe hypocalcemia can be life-threatening. Vitamin D is prescribed as a long-term treatment.
FAQs
Parathyroid glands | Encyclopaedia? ›
The parathyroid glands lie just behind the thyroid glands in the neck. The parathyroid glands (light pink) produce parathyroid hormone, which increases levels of calcium in the blood. The parathyroid glands are small pea-sized glands located in the neck just behind the butterfly-shaped thyroid gland.
What are the signs and symptoms of parathyroid disease? ›- A lump in the neck.
- Difficulty speaking or swallowing.
- Muscle weakness.
- Sudden increase in blood calcium levels (hypercalcemia)
- Fatigue, drowsiness.
- Urinating more than usual, which may cause you to be dehydrated and very thirsty.
- Bone pain and broken bones.
- Kidney stones.
Parathyroid disorders lead to abnormal levels of calcium in the blood that can cause brittle bones, kidney stones, fatigue, weakness, and other problems.
Can you live without parathyroid? ›Parathyroid glands control the amount of calcium in your blood. Parathyroid glands control the amount of calcium in your bones. You can easily live with one (or even 1/2) parathyroid gland. Removing all 4 parathyroid glands will cause very bad symptoms of too little calcium (hypOparathyroidism).
Which symptom would a person whose parathyroid is not functioning properly have? ›The most common symptoms of hyperparathyroidism are chronic fatigue, body aches, difficulty sleeping, bone pain, memory loss, poor concentration, depression, and headaches. Parathyroid disease also frequently leads to osteoporosis, kidney stones, hypertension, cardiac arrhythmias, and kidney failure.
Does parathyroid affect weight? ›Parathyroid disease and hyperparathyroidism are associated with weight gain. The worries about gaining weight after parathyroid surgery are understandable but unfounded. It is a myth that parathyroid surgery and removing a parathyroid tumor causes you to gain weight.
What triggers parathyroid disorders? ›Your kidneys convert vitamin D into a form that your body can use. If your kidneys work poorly, usable vitamin D may decrease and calcium levels drop. This causes parathyroid hormone levels to go up. Chronic kidney failure is the most common cause of secondary hyperparathyroidism.
How do you fix parathyroid problems? ›Treatment options for the parathyroid disease include monitoring, medication, dietary supplements, and surgery. Surgery is the most effective option to treat the disease. It involves removing overactive parathyroid glands and can be performed either in a minimally invasive way or by a standard neck exploration.
Should you take vitamin D if you have hyperparathyroidism? ›If it is determined that you suffer from hyperparathyroid disease and you have parathyroid surgery, it is important that you take calcium and vitamin D supplements to help replenish your calcium stores in your bones.
What tests are done to diagnose parathyroid disease? ›The most common test is a serum calcium test. Elevated serum calcium levels can suggest the presence of a parathyroid tumor or hyperplasia, which are overactive cells, on 1 or more glands. Another common laboratory test looks for elevated levels of the parathyroid hormone (PTH) and phosphorus levels in the blood.
What should you avoid if you have parathyroid? ›
Avoid refined foods, such as white breads, pastas, and sugar. Use healthy cooking oils, such as olive oil or coconut oil. Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, and donuts, French fries, onion rings, processed foods, and margarine.
Can parathyroid disease reversed? ›Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases. A surgeon will remove only those glands that are enlarged or have a tumor.
What is the life expectancy of someone with hypoparathyroidism? ›Living with hypoparathyroidism
Many people with Hypopara can expect to lead normal lives with a normal life span. With permanent but mild Hypopara, temporary symptoms may occur from time to time.
There's actually some preliminary data to show that patients with parathyroid disease do actually have higher rates of disordered sleep or insomnia, and that's mostly done by sleep questionnaires.
Can parathyroid affect your eyes? ›Primary hyperparathyroidism primary hyperthyroidism may also sometimes present with significant ocular manifestations. The commonly described ocular manifestations of hyperparathyroidism include band keratopathy, asymptomatic conjunctival calcification, and conjunctivitis.
What organ does parathyroid hormone affect? ›Organ Systems Involved
Parathyroid hormone is directly involved in the bones, kidneys, and small intestine. In the bones, PTH stimulates the release of calcium in an indirect process through osteoclasts which ultimately leads to the resorption of the bones.
Along with hair loss, HPT patients may experience symptoms that range from mild to severe, and these symptoms include osteoporosis, abdominal pain, and fatigue. These symptoms indicate one or more of the parathyroid glands may be defective — and should be addressed immediately.
Will I lose weight after parathyroid removal? ›In some instances, weight loss occurs following parathyroid surgery. Hyperparathyroidism patients sometimes experience chronic fatigue, which makes them less active and more prone to weight gain.
Does parathyroid affect energy levels? ›“The symptoms of hyperparathyroidism are often vague and include fatigue, minor mental changes, or mild depression,” says Dr. Kim. “Many patients don't even realize they have a problem, but just assume they're getting old.
What autoimmune disease affects parathyroid? ›Autoimmune hypoparathyroidism can occur as part of a larger autoimmune syndrome (complex of diseases occurring together in the same person) that damages many organs of the body or as isolated damage to the parathyroid glands. This may be called the autoimmune polyendocrine syndrome type 1 or APS1.
What mimics parathyroid disease? ›
- Hyperparathyroidism.
- Allergic rhinitis.
- Benign prostatic hyperplasia.
- Common cold.
- Gastroesophageal reflux disease.
- Chronic fatigue syndrome.
- Irritable bowel syndrome.
- Cough.
Most people with asymptomatic primary hyperparathyroidism can have a fairly benign course for years, even a lifetime. But hyperparathyroidism does progress in some people, and they should undergo surgery, which is the only complete cure.
Can vitamin D cure parathyroid? ›Vitamin D supplementation typically leads to the reductions in serum parathyroid hormone (PTH) levels, as shown in normal weight individuals. Meanwhile, the dose of vitamin D supplementation for the suppression of PTH may differ in overweight and obese adults.
What kind of doctor treats parathyroid issues? ›Endocrinology. Endocrinologists are typically the first line in establishing a diagnosis of parathyroid disease and setting up a treatment plan, and they help coordinate your care with other specialists.
What are natural remedies for parathyroid? ›Six natural remedies that can help manage symptoms and support recovery include: eating a healthy diet, treating bone and joint pain with exercise and more, managing depression and fatigue, preventing vitamin D deficiency, quitting smoking and managing nausea.
Is coffee bad for parathyroid? ›Therefore, high doses of caffeine intake may inhibit pulsatile secretion of PTH. In the parathyroid cell, [Ca2+]i is a central player for PTH secretion, in which high levels of [Ca2+]i result in reduced secretion of PTH.
Is turmeric good for the parathyroid? ›Turmeric inhibits parathyroid hormone-related protein (PTHrP) secretion from human rheumatoid synoviocytes.
What happens if parathyroid hormone is high? ›Too much PTH causes calcium levels in your blood to rise too high, which can lead to health problems such as bone thinning and kidney stones. Doctors usually catch primary hyperparathyroidism early through routine blood tests, before serious problems occur.
How do I know if my parathyroid is cancerous? ›Signs and symptoms of parathyroid cancer include weakness, feeling tired, and a lump in the neck. Tests that examine the neck and blood are used to diagnose parathyroid cancer. Certain factors affect prognosis (chance of recovery) and treatment options.
What is an alarming calcium level? ›What Is a High Calcium Level? Your blood calcium level would be considered high if it surpasses the upper limit of the normal range, meaning it is greater than 10.3 mg/dl.
Can you feel a parathyroid tumor in your throat? ›
Dysphagia, neck discomfort and sore throat are among common symptoms of parathyroid adenoma. Reports reveal that pain, swelling, tenderness in anterior neck, dysphagia, hoarseness, and ecchymosis are among the usual presentations of parathyroid adenoma.
Are eggs bad for hyperparathyroidism? ›Secondary hyperparathyroidism
Treatment in CKD includes: Treatment to lower your blood phosphate level. You can reduce your intake of phosphate by restricting the amount of milk, cheese, eggs and dairy products that you eat. You may also need some medication such as calcium carbonate.
Very less is understood regarding the impact of caffeine on PTH and its use in hyperparathyroidism. Based on the data reviewed, it is evident that caffeine can be used as adjuvant therapy in parathyroid adenomas to suppress the PTH level until parathyroidectomy is performed.
What foods should I eat to lower my calcium levels? ›Foods high in oxalic acid also impede the absorption of calcium by binding the mineral. Spinach is naturally high in calcium, but it is also high in oxalic acid. The body is unable to process the calcium it provides. Other foods that contain oxalic acid include beet greens, rhubarb and sweet potatoes.
Is parathyroid surgery a big deal? ›Parathyroidectomy is generally a safe procedure. But as with any surgery, it carries a risk of complications. Potential problems that could happen after this surgery include: Infection.
Is parathyroid disease fatal? ›The simple answer is this: yes. Having high calcium in your blood is much more dangerous than having high cholesterol. Having high blood calcium is more deadly than having thyroid cancer. In fact, having a parathyroid tumor caries the same risk of early death as having diabetes.
When should a parathyroid be removed? ›Your health care provider may recommend this surgery if one or more of your parathyroid glands is producing too much parathyroid hormone. This condition is called hyperparathyroidism. It is often caused by a small non-cancerous (benign) tumor called an adenoma.
Is parathyroid disease terminal? ›Calcium level in the blood
People with parathyroid cancer and uncontrolled high levels of calcium in the blood (hypercalcemia) have a poor prognosis. People with parathyroid cancer who die from it will probably die from uncontrolled hypercalcemia and its complications.
Symptoms may include painful spasms of your face, hands, arms, and feet. They may also include a burning or prickling feeling in your hands and feet, and around your mouth. Blood tests can spot low levels of calcium and parathyroid hormones.
What organs are affected by hypoparathyroidism? ›Hypoparathyroidism occurs when the parathyroid glands don't produce enough parathyroid hormone. There are four small parathyroid glands in the neck behind the thyroid gland. Parathyroid hormone controls the levels of calcium and phosphorus, so too little parathyroid hormone causes abnormal levels of: Calcium.
Does parathyroid affect urination? ›
Too much PTH leads to too much calcium in your blood. This condition is called hypercalcemia. It can cause a variety of symptoms, including: frequent urination.
Can parathyroid affect teeth? ›Parathyroid disorder may lead to hyper or hyposecretion of hormone, which results in various oral manifestations. Common oral manifestations in patients with hyperparathyroidism (HPT) are brown tumor, loss of bone density, soft tissue calcification, and dental abnormalities.
Does parathyroid affect anxiety? ›Furthermore, research published by the Southern Illinois University School of Medicine indicated anxiety has been found in up to 53% of PHPT patients.
Does parathyroid affect skin? ›Dermatologic manifestations of parathyroid-related disorders, although rare in sporadic cases, are not uncommon in familial syndromes. Patients with familial hyperparathyroidism have several types of skin lesions.
Do you feel different after parathyroid? ›What are the side effects of a parathyroidectomy? You may experience temporary changes to your voice, including hoarseness, which generally improves within the first month after your surgery. You may also experience temporary low blood calcium levels, which can often be managed with calcium supplements.
How does the parathyroid gland affect behavior? ›Likewise, too much parathyroid hormone causes too high a calcium level--and this can make a person feel run down, cause them to sleep poorly, make them more irritable than usual, and even cause a decrease in memory.
Can you live without parathyroid glands? ›Parathyroid glands control the amount of calcium in your blood. Parathyroid glands control the amount of calcium in your bones. You can easily live with one (or even 1/2) parathyroid gland. Removing all 4 parathyroid glands will cause very bad symptoms of too little calcium (hypOparathyroidism).
What foods should you avoid if you have hypOparathyroidism? ›Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. Also avoid French fries, onion rings, processed foods, and margarine. Limit carbonated beverages. They are high in phosphates, which can leach calcium from your bones.
What is the most common parathyroid condition? ›Hyperparathyroidism. Hyperparathyroidism (HPT) is the most common type of parathyroid disease. In HPT, one or more glands are overactive. As a result, the glands make too much PTH.
How do you detect parathyroid disease? ›The most common test is a serum calcium test. Elevated serum calcium levels can suggest the presence of a parathyroid tumor or hyperplasia, which are overactive cells, on 1 or more glands. Another common laboratory test looks for elevated levels of the parathyroid hormone (PTH) and phosphorus levels in the blood.
What is the first symptom of primary hyperparathyroidism? ›
Frequent urination. Increased thirst. Joint pain. Kidney pain (due to the presence of kidney stones)
What is a common side effect of parathyroid hormone? ›Commonly reported side effects of parathyroid hormone include: decreased serum calcium, diarrhea, hypercalcemia, increased serum calcium, increased urine calcium excretion, vomiting, and hypocalcemia.
What is the best treatment for parathyroid disease? ›Treatment options for the parathyroid disease include monitoring, medication, dietary supplements, and surgery. Surgery is the most effective option to treat the disease. It involves removing overactive parathyroid glands and can be performed either in a minimally invasive way or by a standard neck exploration.
What is the cure for parathyroid disease? ›Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases. A surgeon will remove only those glands that are enlarged or have a tumor.
What foods should you avoid if you have hyperparathyroidism? ›Avoid refined foods, such as white breads, pastas, and sugar. Use healthy cooking oils, such as olive oil or coconut oil. Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, and donuts, French fries, onion rings, processed foods, and margarine.
How long can you have hyperparathyroidism without knowing? ›Sometimes hyperparathyroidism makes people miserable within the first year or two of having high blood calcium (see our page on symptoms of hyperparathyroidism). Other times it can go 10 years without causing too much problems other than fatigue, bad memory, kidney stones, and osteoporosis.
What kind of doctor treats parathyroid disease? ›Endocrinology. Endocrinologists are typically the first line in establishing a diagnosis of parathyroid disease and setting up a treatment plan, and they help coordinate your care with other specialists.
What organs does the parathyroid affect? ›Organ Systems Involved
Parathyroid hormone is directly involved in the bones, kidneys, and small intestine. In the bones, PTH stimulates the release of calcium in an indirect process through osteoclasts which ultimately leads to the resorption of the bones.
Along with hair loss, HPT patients may experience symptoms that range from mild to severe, and these symptoms include osteoporosis, abdominal pain, and fatigue. These symptoms indicate one or more of the parathyroid glands may be defective — and should be addressed immediately.