August 20, 2014 at 1:00 am

To Your Health

Hyperparathyroidism surgery recommended

Dear Dr. Roach: My primary-care doctor sent me to an endocrinologist after my blood test showed that I have high calcium levels in my blood (10.7 and 10.8) and very low vitamin D levels. I had a bone density test, which showed osteopenia, especially in my left hip. I was told that I have hyperparathyroidism, and the only treatment is to have the affected parathyroid glands removed.

I was told to come back in six months, unless I want surgery now.

My questions have multiplied since my last appointment. I have researched this disease a bit on the Web, and I find the symptoms confusing. I had attributed any symptoms to old age (I am 65). Is this a concern? Is surgery necessary? Who does this kind of surgery? I read that I will need an accomplished surgeon with plenty of experience in parathyroid surgery to assure no damage to my vocal cords.

P.C.

Dear P.C.: The parathyroids are four (usually) small glands that are found right around the thyroid gland in the neck. They secrete parathyroid hormone, which is absolutely critical to calcium metabolism, working with vitamin D to adjust absorption and excretion of calcium, as well as movement of calcium into and out of bones.

Once in a while, for no known reason, one (usually) of these glands starts making more hormone than the body needs, and if the levels are high enough, it causes high levels of calcium in the blood at the expense of calcium in the bone. If this goes on too long, osteoporosis can result. Other symptoms related to high calcium include depression and kidney stones.

Surgery is recommended for people with symptoms, but symptoms can be vague and, as may be the case with you, attributed to other conditions or just aging. Because treatment reduces bone fracture risk and kidney stones, and may improve quality of life, many authorities recommend surgery for asymptomatic people. Surgery is clearly indicated in people with very high calcium levels, poor kidney function, osteoporosis or an osteoporotic-type fracture, and anyone under 50. I would recommend surgery for most healthy women of your age with osteoporosis, but there are medical alternatives, which certainly would include getting your vitamin D levels back to normal and might include anti-osteoporosis medicines, such as alendronate (Fosamax).

Should you choose to pursue surgery, finding an experienced surgeon is essential. They are usually general surgeons who have specialized in doing parathyroid surgery. As a medical student, I trained with a surgeon in Chicago (who still practices) who was absolutely meticulous in his surgical care and who routinely operates on professional singers. Many academic centers have similar experts.

Email questions to ToYourGoodHealth@med.cornell.edu.