Secondary hyperparathyroidism is caused by a disease outside the parathyroid glands that causes them to grow and make too much parathyroid hormone (PTH). Vitamin D deficiency and kidney failure are the most common causes of secondary hyperparathyroidism.
Doctors diagnose parathyroid disease and parathyroid cancer by measuring hormone levels, imaging and tumor biopsy by a pathologist (our cellular experts). The main goal is to get a correct diagnosis of your condition — often at the genetic level so we can identify the best treatments.
The goal of treatment for secondary hyperparathyroidism is fixing the vitamin D deficiency or kidney failure. Treatment for vitamin D deficiency involves raising the vitamin D levels to the normal range. For patients with secondary hyperparathyroidism from kidney failure, the only treatment is a kidney transplant. Until then, the best treatment is medical therapy.
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)
MRI may be used in cases where ultrasound, sestamibi, and high-resolution CT scans are negative or in re-operative parathyroid surgery.
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
Medical Therapy
Medical therapy options may include phosphate binders and vitamin D supplements (like calcitriol and calcimimetics), which lower the PTH levels by about 50 percent on average.
Surgery
Because medical therapy doesn't work for up to 25 percent of patients, surgery is sometimes necessary to treat problems such as weakened bones, severe itching, high PTH levels and high calcium and phosphorus levels that can't be lowered with dialysis.
Four-Gland Excision Auto-Transplantation
Parathyroid auto-transplantation involves removing all four parathyroid glands and taking part of one gland and placing it into your forearm muscle. This offers easy access in the future if it becomes overactive. It takes time for the transplanted gland to develop a blood supply and start producing PTH, so you'll need to take calcium and vitamin D supplements, and occasionally intravenous calcium, until the gland functions normally.
PTH-Guided Parathyroidectomy
In this surgery, the surgeon removes enough parathyroid tissue to bring the PTH levels to between 200 and 300.
Subtotal Parathyroidectomy
This surgery involves removing part of the parathyroid glands, leaving some functioning tissue.
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.
Questions? We're here to help.
Our appointment specialists are ready to help you find what you need. Contact us today.