Parathyroid Conditions

Primary hyperparathyroidism

At Hammersmith Endocrine Surgery we specialise in diagnosing and treating primary hyperparathyroidism. In this condition, there is overproduction of parathyroid hormone from one or more than one of the parathyroid glands. Parathyroid hormone (‘PTH’) causes calcium release from the bones and reabsorption from the bowel and kidneys. The effect is an elevated level of calcium in the bloodstream. Damaging effects of hyperparathyroidism include thinning of the bones (osteoporosis), kidney stones and/or declining kidney function and in the long term stiffening of the blood vessels in the heart and brain. It is therefore beneficial to stop these processes by treating the hyperparathyroidism. This requires surgery to remove the overactive parathyroid gland/glands.
There are usually four parathyroid glands, any one of which may be affected, and so scans are performed to guide your surgery. Not infrequently, these scans are unhelpful / negative. This does not mean that a person does not have the disease or cannot be treated, simply that the surgery needs to be undertaken by an experienced endocrine surgeon.

See our work on unlocalised parathyroid disease here:
Your surgical team will discuss parathyroid surgery with you and what to expect.

In rare cases, the overactive parathyroid gland is located in an abnormal (‘ectopic’) position such as in the chest cavity. At the Hammersmith Endocrine Surgery we work in a multidisciplinary team including cardiothoracic surgeons specialising in treating people with these ectopic mediastinal parathyroid glands.

Read about our work on this here:

Renal hyperparathyroidism

If you have chronic kidney disease this may cause your parathyroid glands to become overactive and if this cannot be controlled with medications from your kidney doctors, they will refer you for parathyroid surgery.

The Hammersmith Hospital houses Europe’s largest kidney dialysis unit and so the Hammersmith Endocrine Surgical team have extensive experience looking after patients needing parathyroid surgery for this reason.

Your surgical team will discuss the best surgical procedure for you: total parathyroidectomy involves removing all of the parathyroid glands and is most suitable if you are not going to have a kidney transplant in the future. Subtotal parathyroidectomy involves removing 3 / 3.5 out of the four parathyroid glands and is best if you are likely to undergo a kidney transplant in future.

Prior to your surgery, your kidney doctors will prepare you by asking you to take extra active vitamin D tablets (alfacalcidol pre-loading) which helps manage your calcium balance after surgery.