Can You Get Hyperparathyroidism Twice?
While rare, the answer is yes, you can get hyperparathyroidism twice, though it’s more accurately described as recurrent or persistent hyperparathyroidism. This usually arises from incomplete initial treatment or the development of new issues affecting the parathyroid glands.
Understanding Hyperparathyroidism
Hyperparathyroidism is a condition characterized by overactivity of one or more of the parathyroid glands. These small glands, located in the neck near the thyroid gland, produce parathyroid hormone (PTH), which regulates calcium levels in the blood. When the glands become overactive, they produce too much PTH, leading to high calcium levels (hypercalcemia).
- Primary hyperparathyroidism is most often caused by a noncancerous growth (adenoma) on one of the parathyroid glands. Less commonly, it is caused by enlargement (hyperplasia) of two or more glands, or rarely, by a cancerous tumor.
- Secondary hyperparathyroidism is caused by another condition, such as chronic kidney disease or vitamin D deficiency, which causes the parathyroid glands to overcompensate.
- Tertiary hyperparathyroidism occurs when secondary hyperparathyroidism is left untreated for a long time, causing the parathyroid glands to become autonomous and overproduce PTH even after the underlying cause is addressed.
Why Recurrence or Persistence is Possible
So, can you get hyperparathyroidism twice? The answer lies in understanding the various reasons why elevated PTH levels can persist or return after initial treatment:
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Incomplete Initial Surgery: The most common cause of persistent or recurrent hyperparathyroidism is an incomplete initial surgery. This can happen if:
- All affected parathyroid glands were not identified and removed during the first operation.
- The surgeon removed the wrong gland, perhaps mistaking it for a lymph node.
- A supernumerary (extra) parathyroid gland was missed.
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Glandular Hyperplasia: When multiple glands are enlarged (hyperplasia), it can be difficult to remove all the affected tissue. Microscopic foci of hyperplastic tissue can remain and eventually grow, leading to recurrent hyperparathyroidism.
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New Adenoma Formation: A new adenoma can develop in one of the remaining parathyroid glands after successful removal of a previous adenoma. This is less common than incomplete surgery but is still a possibility.
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Parathyroid Carcinoma: Although rare, parathyroid carcinoma can sometimes be mistaken for a benign adenoma initially. Recurrence is more likely in cases of parathyroid cancer.
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MEN Syndromes: Multiple Endocrine Neoplasia (MEN) syndromes are genetic conditions that predispose individuals to developing tumors in multiple endocrine glands, including the parathyroid glands. Individuals with MEN syndromes are at higher risk of developing hyperparathyroidism repeatedly.
Diagnosing Recurrent Hyperparathyroidism
The diagnosis of recurrent hyperparathyroidism involves:
- Blood Tests: Measuring PTH and calcium levels remains the cornerstone of diagnosis. Elevated levels after previous treatment strongly suggest recurrence.
- Imaging Studies: These are crucial for localizing the source of the elevated PTH. Options include:
- Sestamibi Scan: This nuclear medicine scan uses a radioactive tracer to identify overactive parathyroid glands.
- Ultrasound: An ultrasound of the neck can help visualize the parathyroid glands and identify any enlarged glands.
- CT Scan or MRI: These imaging techniques can provide more detailed images of the neck and mediastinum (the space between the lungs).
- Selective Venous Sampling: This invasive procedure involves drawing blood samples from veins near the parathyroid glands to measure PTH levels and pinpoint the source of excess hormone production.
Treatment Options for Recurrent Hyperparathyroidism
Treatment for recurrent hyperparathyroidism typically involves:
- Surgery: Repeat surgery is the most common treatment. Success rates are generally lower than with the initial surgery due to scar tissue and altered anatomy.
- Minimally Invasive Parathyroidectomy: A targeted surgical approach guided by pre-operative imaging to remove only the overactive gland.
- Medical Management: In some cases, medical management with medications like calcimimetics (e.g., cinacalcet) may be used to lower calcium levels if surgery is not an option or is unsuccessful.
| Treatment Option | Advantages | Disadvantages |
|---|---|---|
| Repeat Parathyroidectomy | Potentially curative | Higher risk of complications, lower success rate compared to initial surgery |
| Minimally Invasive Surgery | Smaller incision, faster recovery | Requires precise localization of the affected gland, may not be suitable for all patients |
| Medical Management | Avoids surgery, can be effective in lowering calcium levels | Doesn’t address the underlying cause of hyperparathyroidism, potential side effects |
FAQs on Recurrent Hyperparathyroidism
Can I develop hyperparathyroidism again even after successful surgery?
Yes, it’s possible, though not common. If any hyperactive parathyroid tissue was missed during the initial surgery or if a new adenoma develops in another gland, hyperparathyroidism can recur.
What are the symptoms of recurrent hyperparathyroidism?
The symptoms are similar to those of the initial diagnosis, including fatigue, bone pain, kidney stones, excessive thirst, frequent urination, constipation, and cognitive problems. High calcium levels found incidentally on routine blood work may be the first indication.
How soon after the first surgery can hyperparathyroidism recur?
Recurrence can happen anywhere from a few months to many years after the initial surgery. Regular monitoring of calcium and PTH levels is crucial.
Are there any lifestyle changes that can prevent recurrence?
There are no specific lifestyle changes that can guarantee prevention, but maintaining adequate vitamin D levels and staying well-hydrated can support overall bone health. Following your doctor’s recommendations for calcium and vitamin D supplementation is essential.
What is the success rate of repeat parathyroid surgery?
The success rate of repeat parathyroid surgery is generally lower than that of the initial surgery, often ranging from 60% to 80%, due to scar tissue and altered anatomy.
If I have MEN syndrome, am I more likely to get hyperparathyroidism again?
Yes, individuals with Multiple Endocrine Neoplasia (MEN) syndromes are at significantly higher risk of developing recurrent hyperparathyroidism due to the genetic predisposition for multiple endocrine tumors.
What if I can’t undergo another surgery?
If surgery is not feasible due to medical conditions or patient preference, medical management with calcimimetics like cinacalcet can help control calcium levels and alleviate some of the symptoms.
How often should I get my calcium and PTH levels checked after parathyroid surgery?
Your doctor will recommend a specific follow-up schedule based on your individual circumstances, but typically, calcium and PTH levels are checked regularly in the months and years following surgery.
Is recurrent hyperparathyroidism dangerous?
Yes, untreated recurrent hyperparathyroidism can lead to the same complications as primary hyperparathyroidism, including osteoporosis, kidney stones, cardiovascular problems, and cognitive impairment.
Does the type of surgery I had the first time affect my risk of recurrence?
The extent and accuracy of the initial surgery are key factors. If a minimally invasive approach was used and the adenoma wasn’t completely removed, the risk of recurrence may be slightly higher compared to a bilateral neck exploration where all four glands were visualized.
Are there any non-surgical treatments besides calcimimetics?
Bisphosphonates can help strengthen bones in patients with osteoporosis due to hyperparathyroidism, but they do not treat the underlying cause of elevated PTH. Denosumab is another bone-strengthening agent that may be used.
How can I find a surgeon who specializes in recurrent hyperparathyroidism?
Seek out an experienced endocrine surgeon at a high-volume center. Ask about their experience with repeat parathyroid surgery and their success rates. You can also consult with an endocrinologist who specializes in parathyroid disorders for recommendations.