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The parathyroid gland is made up of four small glands behind the thyroid gland. They usually are 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. The parathyroid glands may be misplaced in other glands but still work normally.
Parathyroid Disease Types
Hyperparathyroidism means the parathyroid makes too much PTH. Usually this is caused by an adenoma, which is a benign tumor on the parathyroid. Too much PTH may cause too much calcium in the blood, which is called hypercalcemia. This can cause serious problems, including osteoporosis (weakening of the bones) and kidney stones.
Cancer of the parathyroid glands is extremely rare. Sometimes parathyroid cancer causes hyperparathyroidism (HPT), which means the body makes too much PTH. However, less than 1% of people with HPT have parathyroid cancer. Men and women have the same risk for parathyroid disease, 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 36% to 80% of patients, anywhere from one month to 19 years after it was first treated. The average time before return is about two and a half years. Controlling the level of calcium in the blood can help people have longer disease-free periods between recurrences.
Hypoparathyroidism means the body does not make enough PTH and the calcium level in the blood is too low. Hypoparathyroidism usually is caused by neck surgery or damage to the parathyroid glands.
Parathyroid Disease Risk Factors
Anything that increases your chance of getting parathyroid disease is a risk factor.
Having certain inherited disorders can increase your risk of developing parathyroid cancer. These include:
- Familial isolated hyperparathyroidism (FIHP)
- Multiple endocrine neoplasia type 1 (MEN1)
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.
Many times, parathyroid disease does not have symptoms in the early stages. When it does have symptoms, they vary from person to person. If you have symptoms, they will depend on the type of disorder you have.
- Low energy
- Feeling tired (fatigue)
- Loss of appetite
- Muscle weakness
- Bone or joint pain
- Anxiety or depression
- Kidney stones
- Bone loss
- Broken bones
Parathyroid Disease Symptoms
- 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
- Nausea and vomiting
- Loss of appetite
- Numbness, tingling
- Muscle cramps or spasms
Diagnosing parathyroid disease can be challenging. It is important to see an expert with a high level of experience in recognizing it. Our endocrinologists and pathologists specialize in parathyroid disease diagnosis, and they are among the most experienced and skilled in the nation.
Biopsy is generally not indicated for either the benign or cancerous parathyroid tumors. Hypercalcemia and fatigue are usually the most common signs of parathyroid disorders.
If you have symptoms that may signal parathyroid disease, your doctor will examine you and ask questions about your medical history. One or more of the following tests may be used to find out if you have cancer and if it has spread.
These tests also may be used to find out if treatment is working. If you have parathyroid cancer, tests may be done to see if the cancer has spread to other parts of the body.
Imaging tests, which may include:
- CT or CAT (computed axial tomography) scans
- MRI (magnetic resonance imaging) scans
- Bone density test
Sestamibi scan: A small amount of radioactive chemical is injected into a vein. If the parathyroid is overactive, the chemical will collect in the gland and show up brightly on a special camera.
As one of the nation’s most active programs for the treatment of endocrine disorders, MD Anderson has a level of experience and skill that surpasses most other centers. This level of expertise can mean a higher likelihood of successful treatment.
Like all surgeries, parathyroid disease surgery is most successful when performed by a specialist with a great deal of experience in the particular procedure.
MD Anderson surgeons are among the most skilled and recognized in the world. They perform a larger number of surgeries for parathyroid disease than most cancer centers, using the least-invasive and most-effective techniques.
Our Parathyroid Disease Treatments
If you are diagnosed with parathyroid disease, your doctor will discuss the best options to treat it. This depends on several factors, including the type of disease and your general health. Your treatment for parathyroid disease will be customized to your particular needs. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
The main treatment for parathyroid cancer is surgical removal of the parathyroid gland where the tumor is located. This is called a parathyroidectomy.
Open parathyroidectomy: The surgeon makes an incision (cut) in the neck and examines the parathyroid glands during surgery. Rarely, the abnormal gland(s) cannot be found and more extensive surgery is needed.
Minimally invasive parathyroidectomy: Some patients may be candidates for a minimally invasive parathyroidectomy. In this procedure, a fiber-optic scope is used to remove the parathyroid gland. This may mean a shorter hospital stay and easier recovery. If the abnormal parathyroid gland(s) cannot be found during this type of surgery, you may need an open parathyroidectomy.
New radiation therapy techniques and remarkable skill allow MD Anderson doctors to target tumors more precisely, delivering the maximum amount of radiation with the least damage to healthy cells. Radiation therapy is sometimes used after surgery for parathyroid cancer, especially for patients at high risk of the cancer coming back or because cancer cells remain in the body after surgery.
Medication may be prescribed to reduce parathyroid hormone and control levels of calcium in blood.
Why choose MD Anderson for parathyroid disease care?
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.
Our program is one of the few in the nation that specializes in both these common (benign) and rare (cancerous) 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 endocrinologists, oncologists, radiation oncologists and surgeons, 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.
Our pathologists specialize in parathyroid disorders and are adept at concise diagnosis of parathyroid disease. If surgery is needed, our highly skilled surgeons employ the latest techniques, including minimally invasive and laparoscopic techniques in some cases.
We are constantly researching new and better ways to fight parathyroid disease. This means we are able to offer clinical trials of new treatments that might not be available elsewhere.
BY Devon Carter
Until recently, decades passed with little progress in improving the survival rates of parathyroid cancer patients. But our specialized, multidisciplinary team led by Naifa L. Busaidy, M.D., and Nancy D. Perrier, M.D., 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.
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