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Hyperplasia

Parathyroid hyperplasia is defined by enlargement of all four parathyroid glands. It occurs in all secondary hyperparathyroidism cases and in a small number of primary hyperparathyroidism cases.

During parathyroid surgery for primary hyperparathyroidism (high calcium preoperatively), I was found to have hyperplasia. My calcium is now normal but I have read that patients with hyperplasia have a higher chance of developing recurrent disease. What are the chances that I will get this again?

Parathyroid hyperplasia in primary hyperparathyroidism can be tricky. Adenomas are straightforward: one "bad" gland is removed, and the normal ones are left behind. With hyperplasia, all four glands are involved, by definition. There are no completely normal glands. This is why we have to remove 3.5 glands, to debulk the parathyroids. In most cases, this produces a long-term cure. Meaning, that...

Primary HPT Hyperplasia Secondary HPT Cure rate

Did lithium cause my parathyroid disease? Many years ago, I took lithium for several months. Recently I was diagnosed with primary hyperparathyroidism. Is the lithium to blame?

Lithium is a known cause of primary hyperparathyroidism, but likely did not cause it in this case. Lithium-associated primary hyperparathyroidism usually occurs after many years (think decades) of lithium therapy. It can cause parathyroid disease in less time, but if the lithium was only taken for several months, many years ago, it is most likely unrelated. Interestingly, lithium-associated...

Primary HPT Multigland disease Lithium Hyperplasia

I have been on lithium for bipolar disease for over 20 years. Recently I was diagnosed with high calcium. One doctor says the high calcium is just a result of the lithium, while another thinks I have primary hyperparathyroidism. Which is it?

This clinical picture is most consistent with lithium-associated primary hyperparathyroidism. Lithium is well-known to cause both hypercalcemia (high calcium) and primary hyperparathyroidism (which itself causes high calcium). In some cases, lithium can cause high calcium that is reversible if you stop lithium. If the calcium has been high for many years, it is less likely to be reversible. It ...

Multigland disease Lithium Hyperplasia

How is parathyroid hyperplasia different from a parathyroid tumor? I had a parathyroid operation for primary hyperparathyroidism and was told that I had hyperplasia. Am I going to have the same benefit from surgery as someone with a tumor?

Parathyroid hyperplasia is a form of hyperparathyroidism in which all four glands are overactive. In the most common form of primary hyperparathyroidism, a patient will have one or two parathyroid adenomas, benign tumors that grow from the parathyroid glands. But some patients have hyperplasia, which is not caused by parathyroid tumors. It is simply an enlargement and overactivity of all of the...

Hyperplasia Outcomes Postop expectations

I'm really worried about becoming hypOparathyroid after parathyroid surgery. How do you prevent that?

Postoperative permanent hypoparathyroidism (a lifelong deficiency of PTH) is a known risk of thyroid and parathyroid surgery. It is a terrible complication, but fortunately it is extremely rare. Note that everyone will have some temporary hypoparathyroidism after parathyroid surgery - this is expected, since the remaining parathyroid glands have been suppressed and are not making much PTH. This...

Postop complications HypOparathyroidism Hyperplasia

For those with primary hyperparathyroidism, are the symptoms of a parathyroid tumor different from hyperplasia?

Primary hyperparathyroidism can be caused by a benign tumor, multiple benign tumors, or hyperplasia (all four parathyroid glands diseased). The symptoms are all the same. With an adenoma, or tumor, there is one diseased parathyroid and the other three glands are all normal. Sometimes you can have multiple adenomas, with two or even three benign tumors and one normal gland. In hyperplasia, all f...

Hyperplasia Symptoms FAQ

Hi Dr. Boone, I had 3 glands removed earlier this year. My question is do I have to worry about my 4th gland? Do they ever go bad over time? Is the way to put my mind at ease to keep checking calcium and PTH levels, and not worry unless they both go high? But I'm taking vitamin D, which will lower my PTH result, right?

This is a great question. Short answer: your 4th parathyroid gland is likely not completely normal. But that doesn't mean it will cause problems. I would recommend following calcium levels annually, just as I recommend for other parathyroid patients. Long answer: First let's review what you had done. You had parathyroid surgery for primary hyperparathyroidism, and during the operation y...

Hyperplasia Operation