Parathyroid Ablation in Lucknow

The parathyroids are four small glands, each about the size of a grain of rice, that lie behind the thyroid in the neck. They are not part of the thyroid. They make a hormone known as PTH, which keeps the calcium in your blood within a narrow range.

In primary hyperparathyroidism, one gland makes too much PTH. Calcium in the blood rises and more is drawn out of the bones. Many people have no symptoms, and the problem is found on a routine blood test. Others notice the following.

• Kidney stones.
• Thinning of the bones, bone pain or fractures.
• Tiredness, muscle weakness, low mood or poor concentration.
• Thirst, passing a lot of urine, constipation or stomach pain.

The diagnosis rests on blood tests, and scans come after. A raised calcium with a high or high-normal PTH points to primary hyperparathyroidism. A raised PTH can also be a response to low vitamin D or kidney disease, which is a different problem, so the cause needs sorting out first.

• Serum calcium, often repeated, because one reading can mislead.
• PTH, the hormone these glands release.
• Vitamin D, since low vitamin D can raise PTH for another reason.
• Kidney function, since kidney disease can also raise PTH.
• Neck ultrasound, to look for an enlarged gland. If ultrasound is unclear, doctors may use other scans.

Our parathyroid package brings together PTH, serum calcium, vitamin D3, a thyroid profile and a neck ultrasound, all tests that doctors commonly ask for. Ultrasound cannot show every parathyroid gland, so a normal scan does not rule the problem out.

Surgery to remove the overactive gland is the standard treatment for primary hyperparathyroidism, and the one with the longest record. A surgeon removes the abnormal gland, often through a small cut, and calcium usually falls to normal soon afterwards. Most people with symptoms, kidney stones, bone loss or a very high calcium are advised to have it.

Doctors do not always operate straight away. If calcium is only mildly raised and you have no symptoms, no stones and healthy bones, regular blood tests and bone checks are an option. Medicines can help control calcium or protect bones in some people, but they do not remove the cause.

Ablation is an option for a small group, such as people with one clearly seen adenoma who cannot have surgery or do not want it. Under ultrasound, a needle is placed into the gland through the skin, and heat or alcohol is used to destroy it. The neck is numbed and the person stays awake.

It is less established than surgery, and the evidence behind it is smaller. It works only if the right gland is found and fully treated. A gland may be treated incompletely, calcium may stay high, and surgery may still be needed later.

Ablation does not suit disease that affects more than one gland. Overactive glands caused by long-term kidney disease, called secondary hyperparathyroidism, are a different problem. The kidney doctor usually manages them, first with medicines.

Treatment can lower calcium, but it is not certain to bring it to normal, and it may have to be repeated. The main risks are these.

• A weak or husky voice if the nerve to the voice box is irritated, usually for a short time.
• Low calcium after treatment, called hypocalcaemia, causing tingling around the mouth or in the fingers, or cramps. Blood calcium is checked afterwards for this reason.
• Pain, bruising or bleeding in the neck, and rarely a collection of blood that presses on the windpipe.
• Heat damage to nearby structures such as the thyroid, windpipe or skin.
• Incomplete treatment of the gland, so that calcium stays high.
• Infection, which is rare.

The decision belongs with an endocrinologist or endocrine surgeon, and with you. Ablation is usually thought about only when the calcium and PTH tests clearly show primary hyperparathyroidism, the scans agree on one gland, and surgery is not suitable or not wanted after a full discussion.

The team reads your referral, blood tests and scans before any plan is made. Only then does the team say whether ablation can be carried out at our centre or elsewhere, and who would perform it. If surgery is the better route, the team tells you so plainly. The interventional radiology page lists other image-guided procedures.