Parathyroid tumors

Overview

Parathyroid cancer can develop anywhere in four pea-sized parathyroid glands which sit on top of the thyroid gland in the neck, near the voice box (larynx). The parathyroid glands produce critical parathyroid hormone (PTH), which the body relies on to store, regulate and use calcium.

A doctor will determine whether the tumor is a rare malignancy or a more common, benign growth called an adenoma. Even if the tumor is cancer-free, it can still raise the amount of the hormone controlling calcium levels — a serious condition called hyperparathyroidism

In hyperparathyroidism, extra hormones grab calcium from the bones and increase the amount absorbed from food, leading to overwhelming levels of the mineral in the blood. This problem, hypercalcemia, is actually more dangerous and life threatening than a malignant parathyroid tumor, and Northwell Health doctors are skilled at treating the condition as well. 

Malignant parathyroid tumors can also cause hyperparathyroidism, but only in rare cases.

Our approach

The multidisciplinary team meets weekly to discuss cases, bringing together experts in various specialties from across the Northwell Health. That ensures that each patient receives the most useful, appropriate and up-to-date treatments. While an ear, nose and throat specialist (otolaryngologist or ENT) will coordinate care, the parathyroid team also includes other Northwell Health experts.

Safeguards to Preserve The Parathyroid and Voice

During surgeries, the doctors watch for the precise moment when the disease is controlled, sparing as much tissue as possible. They carefully monitor vocal chords to protect the patient’s voice. A light touch is important to the physicians — that’s why they use the latest technologies while removing tumors. Those include:  

  • Monitoring Vocal Chord Nerves - Given the proximity of the voice box, the physicians want to make sure they don’t harm the patient’s voice.
  • Intraoperative Parathyroid Hormone (IOPTH) Monitoring - Once levels of the parathyroid hormone are back at safe levels, the doctors know they have the damaged tissue under control and can end the operation without removing more.

Risk factors

The cause of parathyroid cancer is unknown, but researchers have identified a few risk factors:

  • Age: Most cases occur in patients over 30
  • Previous radiation therapy to the head or neck
  • Multiple Endocrine Neoplasia Type I: an inherited disorder that causes tumors

Symptoms

Most parathyroid tumor symptoms are caused by elevated levels of the hormone that regulates calcium, leading to dangerous levels of the mineral in the blood. This condition, hypercalcemia, can cause:

  • Weakness
  • Fatigue
  • Nausea and vomiting
  • Appetite loss
  • Weight loss
  • Extra thirst
  • Increased urination
  • Constipation
  • Trouble thinking clearly

Other symptoms of parathyroid cancer include:

  • Pain in the abdomen, side or back that won’t go away
  • Bone pain
  • A broken bone
  • A lump in the neck
  • Hoarseness or other voice changes
  • Trouble swallowing

Just because someone has these symptoms doesn’t necessarily mean they have parathyroid disease. But they should consider seeing a doctor. 

Diagnosis

Specialists use multiple diagnostic tests to identify parathyroid cancer, including: Physical exam

  • Blood draw - Testing for calcium levels
  • Sestamibi scan - Injecting a small amount of radioactive substance in a vein to find a problematic gland
  • CT scan (CAT scan) - Putting together X-rays from different angles, with dye sometimes injected into veins or swallowed
  • SPECT scan (single photon emission computed tomography scan) - Injecting a small amount of radioactive substance in a vein, then using a special camera to make a 3-D picture
  • Ultrasound - Bouncing sound waves off organs and tissues to make a picture from the echoes
  • Angiogram - Injecting dye into a blood vessel, then taking X-rays to look for blockages
  • Venous sampling - Drawing blood from veins near the parathyroid gland to determine which one is producing too many hormones

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