Parathyroid disorders occur when the four tiny parathyroid glands located behind your thyroid produce either too much or too little parathyroid hormone (PTH). This hormone regulates calcium and phosphorus levels in your blood, which are essential for proper nerve, muscle, and bone function. When these glands malfunction, they can cause hyperparathyroidism (overproduction of PTH) or hypoparathyroidism (underproduction of PTH). These conditions often develop gradually, making early detection through regular health screening important.
Parathyroid Disorder Treatment in Singapore
Parathyroid disorders can impact the body’s calcium balance, affecting bone health and kidney function. These small glands in the neck play a role in regulating calcium and phosphorus levels, and when they malfunction, the effects can be significant. Bone health concerns are present among the ageing population, and proper diagnosis and parathyroid disorder treatment options are available for maintaining health. Endocrinologists can provide evaluation and evidence-based treatment approaches tailored to each patient’s specific condition.
*Individual results and treatment outcomes may vary.*
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
What are Parathyroid Disorders?
Types of Parathyroid Disorders
Primary Hyperparathyroidism
This occurs when one or more parathyroid glands become overactive independently, usually due to a benign tumour (adenoma) or gland enlargement. It may lead to calcium release from bones into the bloodstream.
Secondary Hyperparathyroidism
This develops as a response to low calcium levels caused by other conditions, particularly chronic kidney disease or vitamin D deficiency. The parathyroid glands enlarge and may overproduce PTH to compensate for low calcium levels.
Tertiary Hyperparathyroidism
This form occurs when secondary hyperparathyroidism persists even after the underlying cause has been treated. It can be seen in kidney transplant patients whose parathyroid glands continue producing hormone despite normalised kidney function.
Hypoparathyroidism
This condition results from insufficient PTH production, leading to low blood calcium levels. It can occur after thyroid or parathyroid surgery, though autoimmune conditions or genetic factors can also be responsible.
Causes & Risk Factors
Causes
The underlying causes of parathyroid disorders vary depending on the specific condition:
- Parathyroid adenomas: Benign tumours that can cause primary hyperparathyroidism
- Surgical damage: Accidental removal or damage during thyroid or neck surgery
- Genetic mutations: Inherited conditions such as Multiple Endocrine Neoplasia (MEN) syndromes
- Autoimmune conditions: Immune system attacks on parathyroid tissue
- Radiation exposure: Previous radiation therapy to the head or neck region
- Chronic kidney disease: May lead to secondary hyperparathyroidism due to impaired vitamin D activation
Risk Factors
Several factors may increase the likelihood of developing parathyroid disorders:
- Age and gender: Women over a certain age may have a higher risk than men
- Family history: Genetic predisposition to endocrine disorders
- Previous radiation therapy: Especially childhood radiation exposure to the head and neck
- Prolonged lithium use: Medication for bipolar disorder can affect parathyroid function
- Vitamin D deficiency: Can occur despite year-round sunshine due to indoor lifestyles
- Chronic kidney disease: Affects calcium and phosphate metabolism
- Previous thyroid surgery: Risk of inadvertent parathyroid damage
Signs & Symptoms
Hyperparathyroidism Symptoms
Mild Symptoms
- Fatigue and weakness that may worsen gradually
- Mild cognitive difficulties or “brain fog”
- Occasional heartburn or acid reflux
- Mood changes or irritability
- Mild bone or joint discomfort
Moderate Symptoms
- Kidney stones
- Bone pain and muscle weakness
- Depression or anxiety
- High blood pressure
- Frequent urination and excessive thirst
- Osteoporosis detected on bone density scans
Severe Symptoms
- Osteoporosis with fractures
- Kidney failure or kidney stones
- Hypercalcaemia causing confusion
- Cardiac arrhythmias
- Abdominal pain from peptic ulcers
Pancreatitis
Hypoparathyroidism Symptoms
Early Symptoms
- Tingling in fingertips, toes, and lips
- Muscle cramps in legs and feet
- Dry, coarse skin
- Brittle nails
- Anxiety or mood changes
Advanced Symptoms
- Muscle spasms (tetany)
- Seizures
- Difficulty breathing due to laryngospasm
- Cataracts
- Dental problems
- Heart palpitations
Symptoms of parathyroid disorders often develop slowly over time, making them easy to attribute to ageing or stress. Many patients discover their condition during routine blood tests or after complications develop.
Experiencing these symptoms?
Consider consulting with an endocrinologist for proper evaluation and diagnosis.
When to See a Doctor
Seek immediate medical attention if you experience severe muscle spasms, difficulty breathing, seizures, or signs of severe hypercalcaemia such as extreme confusion or irregular heartbeat. These symptoms may indicate a parathyroid crisis requiring emergency treatment.
Schedule a consultation if you notice persistent fatigue, recurring kidney stones, unexplained bone pain, or changes in mood and cognitive function. Early intervention may be important if you have risk factors such as a family history of parathyroid disorders or previous neck surgery. Women approaching or past menopause should be vigilant, as hormonal changes can mask early symptoms.
During a consultation, an endocrinologist will review your medical history, perform a physical examination focusing on your neck area, and order blood tests to measure calcium, PTH, and vitamin D levels.
*Individual consultation duration may vary based on the complexity of symptoms and medical history.*
Diagnosis & Testing Methods
Accurate diagnosis of parathyroid disorders requires comprehensive testing to measure hormone levels and assess their effects on your body. Blood tests form the cornerstone of diagnosis, measuring serum calcium, ionised calcium, PTH, phosphate, vitamin D, and creatinine levels. These tests are typically performed in the morning after fasting, as calcium levels can fluctuate throughout the day.
24-hour Urine Collection
24-hour urine collection helps evaluate calcium excretion and can differentiate between parathyroid disorders and other causes of abnormal calcium levels. This test also helps assess kidney stone risk and guides treatment decisions.
Imaging Studies
Imaging studies play a role in localising abnormal parathyroid glands before surgery. Sestamibi scanning uses a radioactive tracer that accumulates in overactive parathyroid tissue, providing functional information about gland activity. Ultrasound examination of the neck can identify enlarged glands or adenomas, while 4D-CT scanning offers detailed anatomical information for surgical planning.
DEXA Scan
Bone density testing (DEXA scan) evaluates the impact of parathyroid disorders on bone health, particularly important for patients with hyperparathyroidism who may have developed osteoporosis. Results typically become available, allowing treatment planning.
*Individual results and timelines may vary.*
Treatment Options Overview
Hormone Replacement
For hypoparathyroidism, calcium and active vitamin D (calcitriol) supplementation form the foundation of treatment. Patients require careful dose adjustment to maintain calcium levels within the normal range while avoiding over-treatment that could cause kidney problems. Regular monitoring helps ensure appropriate dosing.
Medications by Class
Calcimimetics like cinacalcet may help control PTH levels in patients with hyperparathyroidism who cannot undergo surgery. These medications work by increasing the sensitivity of calcium-sensing receptors on parathyroid cells, reducing PTH secretion. Treatment typically continues long-term with regular blood test monitoring.
Bisphosphonates may be prescribed for patients with hyperparathyroidism-related osteoporosis who are not surgical candidates. These medications can help preserve bone density and reduce fracture risk, though they don’t address the underlying parathyroid problem.
Monitoring Devices
Continuous calcium monitoring through regular blood tests helps track treatment effectiveness. Some patients may benefit from home monitoring devices for related conditions like blood pressure, particularly those with cardiovascular complications from long-standing hyperparathyroidism.
Lifestyle Interventions
Dietary modifications play a supporting role in managing parathyroid disorders. For hyperparathyroidism, moderate calcium intake (not restriction) combined with adequate hydration may help prevent kidney stones. Hypoparathyroid patients require careful dietary planning to ensure consistent calcium intake throughout the day.
Regular weight-bearing exercise may help maintain bone strength, particularly important for patients with hyperparathyroidism-related bone loss. An endocrinologist can recommend appropriate exercise programmes based on your bone density results and overall health status.
Surgical Options
Parathyroidectomy remains the definitive treatment for primary hyperparathyroidism caused by adenomas or hyperplasia. Minimally invasive techniques using intraoperative PTH monitoring allow precise removal of abnormal tissue while preserving normal glands. Surgery typically requires only an overnight hospital stay.
For patients with four-gland hyperplasia, subtotal parathyroidectomy removes three and a half glands, leaving enough tissue to maintain calcium regulation. Some cases may require total parathyroidectomy with autotransplantation of parathyroid tissue to the forearm for easier future access if needed.
Every patient’s condition is unique.
Our endocrinologist will assess your specific situation and discuss treatment options that may be suitable for you.
Complications if Left Untreated
Untreated hyperparathyroidism may lead to progressive bone loss, which can increase fracture risk, particularly in the spine, hips, and wrists. Chronic elevation of calcium levels may damage the kidneys through stone formation and nephrocalcinosis, potentially resulting in kidney failure that could require dialysis.
Cardiovascular complications may include hypertension, left ventricular hypertrophy, and increased risk of heart attack and stroke. Patients with untreated hyperparathyroidism may face an increased risk of cardiovascular events.
Severe hypercalcaemia can cause neuropsychiatric symptoms, including severe depression, cognitive decline, and, in extreme cases, coma. Gastrointestinal complications such as peptic ulcers and pancreatitis may develop, causing chronic abdominal pain and digestive problems.
Untreated hypoparathyroidism poses different but equally serious risks. Chronic low calcium levels can cause permanent neurological damage, cataracts leading to vision loss, and dental problems, including enamel hypoplasia and increased cavity risk. Severe cases may result in life-threatening laryngospasm or cardiac arrhythmias.
*Individual outcomes may vary. Consult with a healthcare professional for personalised medical advice.*
Prevention
Whilst genetic causes of parathyroid disorders cannot be prevented, several approaches may help reduce the risk of developing secondary problems. Maintaining adequate vitamin D levels through safe sun exposure and supplementation may help prevent secondary hyperparathyroidism. In Singapore’s tropical climate, morning sun exposure combined with vitamin D-rich foods or supplements may be beneficial.
Regular health screening, including calcium and vitamin D level checks, may help identify problems early, particularly for postmenopausal women and individuals with a family history of endocrine disorders. Those undergoing thyroid surgery should discuss parathyroid preservation techniques with their surgeon to reduce the risk of surgical hypoparathyroidism.
Managing chronic kidney disease through proper medical care, blood pressure control, and dietary modifications may reduce the risk of secondary hyperparathyroidism. Limiting excessive calcium supplementation and avoiding prolonged lithium therapy when possible may also help maintain normal parathyroid function.
*Individual results and timelines may vary. This information is provided for educational purposes and should not replace consultation with a healthcare professional.*
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Frequently Asked Questions (FAQ)
Can parathyroid disorders be cured permanently?
Primary hyperparathyroidism caused by adenomas may be treated through surgical removal. Hypoparathyroidism typically requires ongoing management with calcium and vitamin D supplementation. Secondary hyperparathyroidism may improve if the underlying cause (such as vitamin D deficiency) is addressed, though kidney disease-related cases often require ongoing treatment.
*Individual results and treatment outcomes may vary.*
How do parathyroid disorders differ from thyroid problems?
The parathyroid glands are located near the thyroid but serve different functions. The thyroid regulates metabolism through thyroid hormones, while the parathyroid glands control calcium levels through PTH. You can have normal thyroid function with a parathyroid disorder and vice versa. Thyroid surgery carries a risk of affecting the parathyroid glands due to their proximity.
What dietary changes should I make if I have a parathyroid disorder?
Dietary recommendations depend on your specific condition and should be discussed with your healthcare professional. For hyperparathyroidism, this may include maintaining moderate calcium intake rather than restricting it, staying well-hydrated, and limiting caffeine. Hypoparathyroidism patients may need consistent calcium-rich foods throughout the day and should discuss any dietary restrictions with their healthcare provider.
How often will I need blood tests to monitor my condition?
Blood test frequency varies based on individual circumstances and treatment response. Initially, more frequent monitoring may be needed while establishing treatment. Once stable, monitoring schedules typically vary depending on the specific condition and treatment approach. Your endocrinologist will create a monitoring schedule based on your condition and treatment response.
Is parathyroid surgery considered major surgery?
Modern parathyroid surgery is typically performed through a small incision under general anaesthesia. The procedure duration and recovery time can vary depending on individual circumstances and the specific surgical approach used. Your surgeon will discuss the procedure details, recovery expectations, and potential risks during your consultation.
*Individual recovery times and outcomes may vary.*
Can pregnancy affect parathyroid disorders?
Pregnancy can impact calcium metabolism and may affect parathyroid disorders. Parathyroid conditions during pregnancy require careful medical management and monitoring. Women with parathyroid disorders should consult their endocrinologist before conception for proper planning and management throughout pregnancy and breastfeeding.
*Treatment plans should always be individualised and supervised by a healthcare professional.*
Conclusion
Parathyroid disorders, while often overlooked, can impact overall health and quality of life through their effects on calcium metabolism. Early recognition and appropriate treatment may help prevent complications, including osteoporosis, kidney disease, and cardiovascular problems. With advances in diagnostic techniques and treatment options available in Singapore, patients with parathyroid disorders may achieve positive outcomes. The approach involves proper diagnosis, individualised treatment planning, and regular monitoring to support optimal calcium balance.
*Individual results and timelines may vary.*
Take the First Step Towards Better Health
Living with a parathyroid disorder can be challenging, but you don’t have to face it alone. Our endocrinologist has experience diagnosing and treating parathyroid disorders using evidence-based approaches.
Dr Gan Eng Cern
MBBS
MRCS (Edin)
mmed (orl)
FAMS
With over 15 years of experience, Dr Gan specialises in the comprehensive management of a broad range of conditions related to the ear, nose and throat (ENT), and head and neck.
Dr. Gan has contributed to the academic field as a Senior Clinical Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore. He is recognised for his extensive research work, with numerous contributions to reputable international ENT journals. Dr Gan is also highly sought after as a speaker and has shared his surgical knowledge as a surgical dissection teacher at various prominent ENT conferences and courses.
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist (Expat Living Singapore)
- 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College of Surgeons, Academy of Medicine Singapore for best scientific surgical paper)
- 2012 – Human Manpower Development Award (Ministry of Health, Singapore)
- 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS – Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) – Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) – Master of Medicine in ENT (National University of Singapore)
- FAMS – Fellow of the Academy of Medicine Singapore
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