Hyperparathyroidism: An Overview

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Guest: Eric J. Lentsch - Otolaryngology - Head and Neck Surgery (ENT)

Host: Dr. Linda Austin – Psychiatry

Announcer: Welcome to an MUSC Health Podcast.

Dr. Linda Austin: I am Dr. Linda Austin. I am talking today with Dr. Eric Lentsch, assistant professor of otolaryngology here at MUSC. Dr. Lentsch, what is hyperparathyroidism?

Dr. Eric J. Lentsch: Hyperparathyroidism is a disease of parathyroid glands and those are small glands that sit in the neck. They are called parathyroid glands because they sit around the thyroid gland, the major gland in the lower part of the neck. The importance of these glands is that they actually help control the calcium levels in your body and so when a patient has a hyperparathyroid state, the calcium levels are high in the body and this can lead to major complications and problems mainly with the heart, nerves, and muscles.

Dr. Linda Austin: What kinds of complications, what happens?

Dr. Eric J. Lentsch: Well, the typical things we teach medical students are stones, bones, moans and groans and that’s a pneumonic just sort of tell them what symptoms patients with hyperparathyroid have. Stones reversed to kidney stones and when patients have high calcium levels, they are at higher risk for having kidney stones because of those high calcium levels. Bones include bone pain because the calcium, which is elevated in the body, often is actually coming from the bones and the bones are being remodeled by the parathyroid hormone levels and causing bone pain. Stone, bones, and moans actually refers to psychic moans and it’s because a fair number of patients somewhere in the order of 10% to 15% with hyperparathyroidism actually have psychiatric issues related to that and that could be either depression or other mood disorders, which can actually be diagnosed and are secondary to their hypercalcemia. Groans; fourth element of the pneumonic is talking about abdominal pain, which a certain percent of the patients will actually present with and can be quite incapacitating at times.

Dr. Linda Austin: Who is prone to getting hyperparathyroidism?

Dr. Eric J. Lentsch: Most patient with hyperparathyroidism are actually middle-age women. It’s actually fairly unique, about 90% of our patients fall into that category. We are not entirely clear as to why that occurs, but it is certainly something that has been well documented.

Dr. Linda Austin: How do you treat it?

Dr. Eric J. Lentsch: It’s treated surgically and it’s interesting because the disease itself is usually found on routine blood test and because of the standardization of routine blood test over the last 10 to 15 years, we are actually finding this disease much earlier than we used to. It used to be that patients would have to present with some of these symptoms beforehand, before we actually got a calcium level. Now, calcium levels on blood test at least are a part of routine testing and we are often finding patients, who are asymptomatic, but they have an elevated calcium level and through a battery of tests we are able to identify that it’s actually an abnormal parathyroid gland that is responsible for the majority of these patients with hypercalcemia. When we find an abnormal parathyroid gland, the treatment for that is actually surgical and a fairly standard operation, which we can do through minimally invasive techniques. It is actually curative for the vast majority somewhere in the order of 95% to 97% of patients.

Dr. Linda Austin: So, it sounds like something that before the days of surgery might have been a very big deal that now-a-days is really pretty easily treated, is that right?

Dr. Eric J. Lentsch:Yes and in fact something that with an outpatient procedure in this day and age, again 95% of the patients are cured with that procedure that what can last as little as 10 or 12 minutes.

Dr. Linda Austin: So, in the course of a year for you, how many of these operations would you guess that you do?

Dr. Eric J. Lentsch: I would say on an average, I treat somewhere between or perform somewhere between one and two of these a week and so you are looking at somewhere around a 100 patients that I am treating. Here, I am part of a group of surgeons five or six of us, who do these operations. So, this is a fairly widespread disease and something that again in capable hands is fairly easily cured.

Dr. Linda Austin: What’s the average age of patients, who has this problem?

Dr. Eric J. Lentsch: Probably, between the ages of 45 and 55.

Dr. Linda Austin: How about kids, do they ever have problems with their parathyroid glands?

Dr. Eric J. Lentsch: It can happen, but it is actually very, very rare. I can count on my hands how many times I had to operate on a child because of this.

Dr. Linda Austin: Dr. Lentsch thanks so much for talking with us today.

Dr. Eric J. Lentsch: Thank you.

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