Meet the Parathyroid
Most people have never heard of the parathyroid glands—or what they do.
Yet these four tiny glands in the neck—each roughly the size of a grain of rice—help regulate calcium levels in the body, which are essential for healthy bones, muscles, nerves, and kidneys. When they don’t work properly, they can cause a range of symptoms that are often mistaken for normal aging or other health conditions.
Even some patients seeing surgeons who specialize in parathyroid disorders aren’t quite sure what they are or what they do.
That’s part of the problem.
“These are not things that people come in knowing about,” says Jennifer Ogilvie, MD, chief of endocrine surgery at Yale Medicine and associate professor of surgery at Yale School of Medicine. “We end up doing a lot of basic education before we can even talk about the condition.”
Even when symptoms appear, they’re easy to dismiss.
“Many of the symptoms are vague,” adds Courtney Gibson, MD, MS, an endocrine surgeon at Yale Medicine. “Fatigue, for example—you can have that for so many reasons. People often just think, ‘this is life, I’m getting older.’”
Despite their small size, parathyroid disorders are relatively common and can cause symptoms that linger, often unexplained, for years. Fortunately, once the underlying problem is identified, treatment can often relieve symptoms and prevent long-term complications.
What are the parathyroid glands?
Although they have similar names, the parathyroid glands have nothing to do with the thyroid. Most people have four of them, located just behind the thyroid in the neck.
Their job is to regulate calcium levels in the body—a function that affects far more than bone health.
“Calcium is a mineral involved in almost every function in the body,” Dr. Ogilvie explains. “Muscle function, heart function, bone strength—it has to be tightly regulated.”
When the parathyroid glands work properly, they keep calcium in a narrow, stable range. But when one, or more than one, becomes overactive (a condition called primary hyperparathyroidism), it can push calcium levels too high, triggering a cascade of effects throughout the body. Those effects include loss of bone strength (osteopenia and osteoporosis), kidney stones and kidney damage, and cognitive effects such as depression, anxiety, and memory loss.
How common is parathyroid disease?
Primary hyperparathyroidism is more common than many people realize.
“It’s probably as high as 1 in 200 women and 1 in 500 men,” Dr. Ogilvie says.
And yet, it frequently goes undiagnosed.
“On average, it can take years before someone checks the right hormone level,” says Adriana Ramirez, MD, MPH, a Yale Medicine endocrine surgeon and assistant professor of surgery at Yale School of Medicine. “You might see elevated calcium over time, but unless someone connects the dots, the diagnosis can be missed.”
Part of the challenge is that there’s no routine screening for many endocrine conditions. Patients often don’t know to look for them—and clinicians may not immediately suspect them.
“Many of these conditions are discovered incidentally, either on lab work over time or imaging that was done for something else,” Dr. Ramirez says.
Even when abnormal results are there, they may not rise to the top of a busy clinical visit.
“In primary care, there are often more immediate concerns—like high blood pressure or blood sugar,” says Dr. Gibson, who is also an associate professor of surgery at Yale School of Medicine. “An isolated elevated calcium level can get overlooked.”
What are the symptoms of parathyroid disease?
Parathyroid disease is so often missed because the symptoms can be vague and are easy to attribute to other causes.
“Patients may feel tired. They feel achy. They don’t feel like themselves,” Dr. Ogilvie says. “There’s this kind of ‘early aging’ picture—not that they look older, but they feel exhausted, forgetful, just not on their game.”
Other symptoms can include:
- kidney stones
- bone loss or osteoporosis
- frequent urination or thirst
- constipation
- difficulty concentrating or memory issues
Individually, these symptoms may not seem connected. Together, they often go unrecognized, because each one has so many other plausible explanations.
“These are all things that could easily be attributed to something else,” Dr. Ramirez says. “Stress, aging, menopause—there are a lot of explanations that come before people think about a hormone problem.”
Many patients normalize how they feel rather than questioning it. “They think their energy is just lower, or their memory isn’t as sharp, and they don’t necessarily recognize that something else could be going on,” says Dr. Gibson.
As a result, some patients live with mildly elevated calcium for years before anyone investigates further. “It just wasn’t picked up as something that needed further evaluation,” Dr. Ramirez says.
How is parathyroid disease diagnosed?
Parathyroid disease is often discovered in one of three ways:
- Routine bloodwork showing elevated calcium
- A complication such as kidney stones
- Evaluation for bone loss or osteoporosis
The key test is measuring parathyroid hormone (PTH) levels in the blood along with calcium. But that test isn’t always ordered right away.
“It often takes someone noticing a pattern over time, or something else, like a kidney stone, to prompt a closer look,” Dr. Ramirez says.
In other cases, patients push for more answers themselves.
“Patients know they don’t feel well, even if everything looks normal on the outside,” Dr. Gibson says. “That often leads them to keep searching for a diagnosis.”
Treatment—and a rapid turnaround for many patients
Unlike some chronic conditions, primary hyperparathyroidism has a clear, effective treatment: surgery to remove the overactive gland.
In most cases, only one of the four glands is affected. “The vast majority have just one gland that becomes overactive,” Dr. Ogilvie says. “And when you take that out, the system resets.”
The procedure is typically minimally invasive and done on an outpatient basis.
What stands out most to many patients is how quickly they feel better, with many noticing changes within days.
“Patients who wake up frequently at night to urinate often see that improve very quickly,” Dr. Gibson says. “Other symptoms, like energy or concentration, can take a little longer—but most patients do notice a difference.”
In fact, some don’t fully realize how much the condition was affecting them until after it’s treated. “I’ve had patients who didn’t think they had symptoms beforehand,” she says. “Then after surgery, they say they feel better—they just didn’t know before that they weren’t feeling their best.”
Outcomes are strong overall, with success rates of about 95%, according to Dr. Gibson. Surgery protects bone density and reduces kidney stone risk for all patients—benefits that build over time even when day-to-day symptoms improve quickly.
“It’s one of those operations where you can really change how someone feels,” Dr. Ogilvie says.
Who treats parathyroid disease?
Parathyroid conditions are usually treated by endocrine surgeons—general surgeons with specialized training in thyroid, parathyroid, and adrenal disorders.
“We focus on tumors or over-secretion of these glands,” Dr. Gibson explains. “Many of these conditions are benign, but the excess hormone production can significantly affect quality of life.”
Endocrine surgeons work closely with endocrinologists and primary care physicians to diagnose and manage these disorders. Because the glands are small and located near important structures, experience matters.
“These are highly targeted operations,” Dr. Gibson says, “and in most cases, we expect very good outcomes.”
