Parathyroid Cancer Symptoms

This article describes the possible symptoms that may occur with parathyroid cancer.  Cancer of the parathyroids is quite rare.  Over active parathyroid glands is more common and affects about 1/1000 people in the United States.  Parathyroid cancer occurs in about 1/1,000,000-5,000,000 people.

The primary function of the parathyroid glands is to assist with calcium regulation.  Calcium is an important element in the body that helps control bone health, muscle function, nerve signal transmission and cell signaling.  The parathyroid gland has a feedback mechanism that functions like a thermostat.  When the calcium level gets low the gland makes more hormones to increase the levels.  When the calcium level returns to normal the hormone production decreases.  The opposite effect would occur if the calcium level was too high.  High calcium in the blood is also known as hypercalcemia.  (The prefix “hyper” meaning elevated, “calc” referring to calcium, and the suffix  “-emia” meaning of the blood.)

The parathyroid hormone regulates calcium by increasing absorption from the intestine of dietary calcium, regulating clearance of the kidney of blood calcium and controls release and storage of calcium in bones.  A normal calcium level as measured in the blood is about 9-10 mg/dL.  Most of this calcium is not dissolved or “free” in the blood, but bound to transport proteins like albumin.  Someone who is malnourished and has abnormal protein levels will thus have less measured calcium in the blood.

Symptoms of parathyroid cancer occur in two major forms.  The first type of symptom relates to the overproduction of parathyroid hormone and the subsequent effects this causes.  The second type of symptom associated with parathyroid cancer relates to growth of the tumor into adjacent areas in the neck causing local problems.

The most common problem that parathyroid cancer causes that generally leads to its discovery is severe elevations in the calcium levels.   Symptoms (and associated findings) of very high calcium include:

  • Severe weakness
  • Lethargy
  • Confusion or altered mental status
  • Vomiting
  • Nausea
  • Abdominal pain
  • Pancreatitis
  • Stomach Ulcers
  • High blood pressure
  • Bone Pain
  • Depression
  • Headache
  • Frequent urination
  • Poor muscle tone (delayed deep tendon reflexes)

Other problems that would be found with further studies would include wide and bizarre waveforms on an electrocardiogram.  Very high serum calcium is frequently associated with parathyroid cancer but there are other causes of high blood calcium.  A partial list of common causes of hypercalcemia includes:

  • Overactive parathyroid glands (not cancer, also known as primary hyperparathyroidism)
  • Parathyroid cancer
  • Excess vitamin D intake
  • Hodgkin’s lymphoma
  • Tumors of the bones or those that spread to the bone
  • Medications side effects (many)

When hypercalcemia is from parathyroid cancer it will generally be greatly elevated.  The above symptoms from hypercalcemia may occur in different levels or combinations.

Other symptoms from parathyroid cancer include those caused by growth of the tumor.  A normal parathyroid gland is not palpable.  An overactive parathyroid gland may be palpable but will be soft and smooth like a soft grape.  A parathyroid gland with cancer in it will feel like a hard rock or pebble within the neck.  As the gland enlarges it will seem fixed to the area and palpation would not be able to “wiggle” it around (technically known as ballottement).  Spread to lymph nodes in that area of the neck may even cause adjacent firm nodules as well.

Sometimes the symptoms of parathyroid cancer are not as dramatic.  The most classic person would be an older man with a firm nodule in the neck and severe weakness, confusion and dehydration.  The only symptom may be more subtle such as pain and blood in the urine.  High calcium levels in the blood lead to crystals of calcium forming in the urine and kidney stones.  These stones are very painful to the kidney and subsequent connecting passages (i.e. ureters, bladder, urethra).  The stones abrade the lining of the ureters or bladder and can cause blood to be seen in the urine and painful urination.

A “spontaneous” fracture may be the initial symptom as well.  For example, an older woman with parathyroid cancer sits down on a hard bench and suddenly has severe pain in the lower back from a fractured vertebra.  The weakness of the bones occurs as parathyroid hormone continuously “tells” the bone to release calcium and undergo breakdown processes despite a normal-high blood calcium level.  In this way it can be understood that both the secretion of the hormone is dysfunctional as well as the calcium thermostat on the gland.

When these key symptoms appear, the essential step is measurement of the blood calcium levels.  When the calcium level is found to be very high, irrespective of the cause, the initial therapy is to lower the calcium level to safe levels.  This can be done by a variety of treatments and requires hospitalization and careful monitoring.  After this step, some type of imaging test (like an x-ray or ultrasound) is done to look for an enlarged gland if it cannot be palpated.  The definitive treatment for parathyroid cancer involves removing the gland with the cancer.  This may involve just the gland or possibly including the thyroid and part of that side of the neck muscle and/or lymph nodes.

REFERENCES:

  1. Townsend Jr, CM; Beauchamp RD; Evers BM; Mattox KL. (2008) Townsend: Sabiston Textbook of Surgery, 18th ed.  Chapter 37.  New York, NY: Saunders.
  2. Cameron JL; Cameron AM.  (2010) Cameron: Current Surgical Therapy, 10th ed. Chapter 610. Philadelphia, PA: Elsevier Saunders
    1. Incidence and prognosis of parathyroid gland carcinoma: A population-based study in The Netherlands estimating the preoperative diagnosis.  Schaapveld M, Jorna FH, Aben KK, Haak HR, Plukker JT, Links TP. Am J Surg. 2011 Aug 20. PMID: 21861982
    2. This article was originally published on September 3, 2012 and last revision and update was 9/4/2015.