Primary hyperparathyroidism (PHP) is a condition that occurs when one or more of your parathyroid glands make too much parathyroid hormone (PTH). A high PTH level can lead to kidney stones or weakened bones, and may also contribute to heart disease and high blood pressure. In most instances, PHP is caused by a single hyperactive gland, but it can be caused by two or more hyperactive glands.
Doctors diagnose parathyroid disease and parathyroid cancer by measuring hormone levels, imaging and, tumor biopsy by a pathologist (our cellular experts). Our main goal is to get a correct diagnosis of your condition — often at the genetic level so we can identify the best treatments.
Tests
Ultrasound Exam of the Neck
Ultrasound uses high-energy sound waves, which bounce off internal tissues or organs to form a picture (sonogram).
Sestamibi Scan
This is a type of radionuclide scan used to find an overactive parathyroid gland. A very small amount of a radioactive substance (technetium 99) is injected into your vein, and it travels through your bloodstream to the parathyroid glands. The radioactive substance will collect in an overactive gland and show up brightly on a special camera that detects radioactivity.
Single Photon Emission Computed Tomography (SPECT) Scan
This procedure creates a 3-D picture using a special camera linked to a computer. You receive an injection of a small amount of a radioactive substance. As the substance travels through your bloodstream, the camera rotates around your neck and takes pictures. Blood flow and metabolism are higher in areas affected by cancer, which show up brighter in the pictures.
High-Resolution CT Scan (4-D CT Scan)
This test looks for abnormal parathyroid glands. It has a 95 percent accuracy rate for identifying abnormal parathyroid glands — far superior to a standard CT scan. You receive a contrast dye as an injection, which travels through your bloodstream and into your parathyroid glands. The health of your glands is determined by their size and how quickly the dye washes in and out of your glands.
Magnetic Resonance Imaging (MRI)
In cases where ultrasound, sestamibi, and high-resolution CT scans are negative or in re-operative parathyroid surgery, MRI may occasionally be used.
Parathyroid Fine-Needle Biopsy
This procedure takes a sample of a nodule that may be a sign of an abnormal parathyroid gland. It also measures your parathyroid hormone levels. It's done using a small needle guided by ultrasound imaging.
Miami Criterion
If imaging doesn’t show which parathyroid gland is involved, your doctor may use this surgical technique to narrow it down. The Miami Criterion, which was pioneered at UHealth, allows surgeons to test which parathyroid gland is over-secreting parathyroid hormone and remove only that gland (or glands) through a tiny incision.
Treatments
Surgery
A surgeon will remove only those glands that are enlarged or have a tumor (adenoma). The parathyroid glands are very close to your voice box, airway, and vocal cord nerves. Sylvester head and neck surgical oncologists have expertise in voice and vocal nerve preservation in people with parathyroid.
Focused Parathyroidectomy
This technique allows your surgeon to test which parathyroid gland is over-secreting parathyroid hormone and remove only that gland through a tiny incision. The procedure, called the Miami Criterion, was developed by a Sylvester Comprehensive Cancer Center surgeon, and it’s used worldwide.
Bilateral Neck Exploration
This technique allows your surgeon to see both sides of your neck and all four parathyroid glands. It helps determine which parathyroid gland (or glands) need to be removed, based on their size, color and texture.
Medical Therapy for Primary Hyperparathyroidism
Medical therapies, which may be used as an alternative to surgery, focus on treating the symptoms of the disease rather than curing it. Types of medical therapies include hormone therapies and medicines that lower blood calcium and prevent calcium loss from bones. Another alternative to surgery may be frequent testing to check your parathyroid hormone and calcium levels.
Calcium Regulation Treatments
Calcimimetic medicines, such as cinacalcet, lower the amount of parathyroid hormone your body makes — they don’t cure the disease. Cinacalcet is FDA approved to treat hyperparathyroidism caused by chronic kidney disease or parathyroid cancer. It may also be prescribed if surgery doesn’t cure the condition or you’re not a good candidate for surgery.
Hormone Replacement
For women who've gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium.
Osteoporosis Medicines
Bisphosphonates are medicines that prevent calcium loss from bones and may lessen osteoporosis caused by hyperparathyroidism.
Why Choose Us?
Only center in South Florida with a specialty endocrine testing center. Our specialized testing centers improves diagnosis accuracy, leading to more precise treatments and better results. Located at the University of Miami Miller School of Medicine, the center is staffed by specialized nurses and technical assistants who perform complex hormone tests.
Advanced radiation oncology tools. We are one of only five medical centers in the country with ViewRay™ — MRI-guided radiation therapy. Our RapidArc® radiotherapy system delivers intensity modulated external radiation therapy (IMRT). These tools lead to more efficient and effective treatments, shorter treatment times, pinpoint accuracy in tumor targeting, and less damage to surrounding healthy tissue.
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