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Hyperparathyroidism is caused by parathyroid glands that grow large and make too much parathyroid hormone.
Over 90% of hyperparathyroid cases are caused by a single parathyroid tumor (called a parathyroid adenoma).
Eight percent are caused by 2 parathyroid adenomas. Less than 3% have 4 enlarged glands called parathyroid hyperplasia.

Remember, NORMAL parathyroid glands are about the size of a grain of rice. It is very important for you to learn that how high the calcium is does not always correlate with the size of the tumor in your neck. You can have a big tumor with calcium levels that are only 10.6 and, you can have a big tumor when your PTH is only 34 if your calcium is high. If you have high calcium in your blood --or-- high PTH in your blood, then you probably have one of these in your neck that needs to be removed. The parathyroid adenoma tumor grew out of the small normal gland.

It is important for all patients to realize that a NEGATIVE sestamibi scan means nothing! It just means that they didn't do the scan correctly to see the tumor, or the tumor is hiding behind the thyroid and they can't see it. If your scan is negative you still have a tumor in your neck! And it must come out!


Important concepts

As you read this page, you need to grasp several concepts:
1) Normal parathyroid glands are very small.
2) The vast majority of patients with parathyroid disease will have one bad parathyroid gland and three small normal glands.
3) The one bad parathyroid gland is actually a tumor which we call a parathyroid adenoma.
4) Most parathyroid adenomas are about the size of an olive or grape and are dark red and firm. Many parathyroid tumors are golf ball size or larger.
5) IMPORTANT, you do NOT need to have high PTH levels to have hyperparathyroidism (one of the most important points, as high calcium levels almost always mean a parathyroid tumor is present regardless of what the PTH level is.
6) You do NOT need to have calcium levels above 12 to have a very serious tumor in your neck.
7) A "negative Sestamibi Scan" does NOT mean that you don't have a parathyroid tumor. It just means that the scan was not done correctly (95% of the time), or that the tumor is small and hiding behind the thyroid (5% of the time).  If you have parathyroid disease then you have a tumor in your neck regardless of whether your scan is negative or not.
8) Most surgeons require you to have a positive sestamibi scan if you want a mini-parathyroid operation but there are some experts who can do mini-parathyroid surgery on EVERY patient, even those who have negative scans.


Mistakes being made in the diagnosis and treatment of hyperparathyroidism

the two most common misconceptions and misunderstandings that many doctors have about hyperparathyroidism:

1- Most doctors who don't see patients with hyperparathyroidism very often will believe that to make the diagnosis of hyperparathyroidism it is reigquired to have high calcium levels AND high PTH levels at the same time. Although having high calcium and PTH levels at the same time occurs in most patients with a parathyroid tumor and hyperparathyroidism, this (simplistic) situation does not occur in about 20% of patients (594 out of 3000 patients did NOT have high calcium and high PTH at the same time).

2- The second biggest mistake made by MANY doctors is that they believe that patients should wait and not go for surgery until their calcium is some arbitrary high number (often they pick the number 12 as the number where the patient should finally get an operation). High calcium is almost always due to a parathyroid tumor, regardless of how high the calcium is. High calcium means parathyroid tumor except in the rarest of circumstances.

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