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Parathyroid Gland Diseases



Where Is The Parathyroid Gland And What Function Does It Have?

The parathyroid glands usually consist of 4 glands, two on each side of the neck, close to the thyroid gland. Their size is usually 3-4 mm, as well as the size of a lentil. They are usually located on the posterior side of the thyroid, near the vein that feeds the thyroid and the nerve that stimulates the vocal cords. Sometimes they can progress to the inside of the rib cage. The parathyroid glands produce a hormone that is essential for the body, called parathyroid hormone. One of the main tasks of this hormone is to ensure a balanced distribution of calcium minaret in the body.

The function of the parathyroid homonym:

Thanks to the parathyroid hormone secreted from the parathyroid glands, it ensures that the blood calcium level is kept within certain limits and therefore the nerves and muscles, heart, kidneys and bones function normally. In order to achieve this, it activates vitamin D and ensures the absorption of calcium from the intestines, the release of calcium from the bones and the retention of calcium from the kidneys.



Diseases of the parathyroid gland

Excessive secretion of parathyroid hormone is called hyperparathyroidism.

These:

primary hyperparathyroidism,

secondary hyperparathyroidism

It is classified as efferent hyperparathyroidism.

Primary Hyperparathyroidism:

It is the most common parathyroid disease. The most common cause of primary hyperparathyroidism is parathyroid adenoma, the second most common in 80%, parathyroid hyperplasia, and very rarely, cancer of the parathyroid gland.

(Parathyroid Adenoma): It is the enlargement of one of the parathyroid glands or, in rare cases, more than one gland, working more than necessary. While there is disease in one gland in approximately 85% or more cases, adenoma in more than one gland or enlargement in all four glands may be found in 15% of cases. It is 2 times more common in women than men. When the parathyroid gland works overtime and too much parathyroid hormone is secreted, calcium dissolution from the bone increases and the amount of calcium in the blood also increases.

As a result of excessive secretion of parathyroid hormone, the calcium in the bones is dissolved and given to the blood, bone resorption occurs, bone pains and bone cavities filled with blood, called "brown tumors" in the bones, and eventually bone fractures occur even in simple movements without a pathological blow.

As a result of high blood calcium level, it collapses in the kidneys and causes kidney stones and kidney damage. Again, high blood calcium levels cause ulcers and gastritis in the stomach and duodenum, constipation and nausea, muscle weakness, hypertension and psychiatric disorders (such as depression, mood disorders).

Parathyroid gland hyperplasia: It is a condition that is usually seen in kidney patients and where four of the 4 glands are overworked. In the treatment of this, 4 glands are laid out and either three and a half glands are removed, half of a gland is preserved, or 4 glands are removed and half of one gland is transplanted.

Parathyroid gland cancer: It is a very rare disease, its treatment is neck dissection in which the parathyroid tissue is removed along with the surrounding porous tissues.



Clinical Symptoms:

Pain in bones, osteoporosis (bone loss) and fractures,

recurrent kidney stones, urinating a lot

Nausea, loss of appetite, ulcer, constipation and pancreatitis in the stomach and intestinal tract

Weakness in the muscles, premature fatigue

Fatigue, difficulty concentrating, memory problems are seen.

Cardiac manifestations are hypertension, bradycardia (decreased pulse rate), decreased QT interval, and left ventricular hypertrophy.

Some of these symptoms may not have even been noticed by the patient, or they may have been thought to be due to other causes; emerges upon detailed inquiry.



Tests required for diagnosis:

Blood calcium level: The patient's blood calcium level and albumin level are measured together or the ionized calcium level is measured. Hypercalcemia is diagnosed when the blood calcium is high at least twice (Because the calcium may be high due to technical mistakes made while drawing blood). Although the normal value of blood calcium varies from laboratory to laboratory, it is usually between 8.5-10.5 mg/dl and ionized calcium is between 1.13-1.32 mmol/L. The blood calcium (Ca) level is related to the albumin level.

Corrected calcium level = Measured total Ca + [0.8 x (4.0 – albumin level)]

When the calcium level is found to be at least twice as high, other tests should be done. The first examination is to measure the level of parathyroid hormone (intact PTH).

If serum calcium is high and parathyroid hormone level is high, the diagnosis of primary hyperparathyroidism is made. 24-hour urine excretion in the urine should be checked, because familial benign hypercalcemia should be eliminated in the diagnosis. In these patients, 24-hour urinary calcium excretion is lower than normal. This FHD disease is very, very rare. Hypercalcemia due to lithium (a drug usually given in manic-depressive illness) should also be considered in the differential diagnosis.

Vitamin D levels in the blood should also be checked. When vitamin D is low, parathormone may be secreted too much to increase it. in blood

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