Parathyroid

Parathyroid adenomas

The most common cause of hyperthyroidism in children older than 15 years of age is a single adenoma. Adenomas usually occur after puberty. Symptoms such as weakness, fatigue, loss of appetite, and irritability are noted in most patients but are often recognized after the fact. Kidney pain, high blood pressure, and headaches are seen commonly in symptomatic patients. Bone disease is much less common.

The diagnosis of primary hyperthyroidism is made if the level of parathyroid hormone and serum calcium is high. Familial hypocalciuric hypercalcemia should be considered and ruled out along with the other causes of hypercalcemia in children. The cause of spontaneously occurring hyperthyroidism is unknown; however, there does seem to be a potential relationship between sporadic parathyroid adenomas and previous head and neck irradiation given in the form of ¹³¹I as used for thyroid treatment. Whether the incidence of hyperparathyroidism in adolescence or early adulthood will increase as more and younger children are given ¹³¹I has yet to be determined.

Once the diagnosis of primary hyperthyroidism has been established, operation is indicated. All four parathyroid glands should be carefully evaluated, and only when exploration has been completed should the enlarged gland with the "adenoma" be excised and a portion of a normal gland sent for frozen section study. The operation is complete when the pathologist confirms that the normal-sized gland is normal and the "adenoma" is not. If the family history shows parathyroid disease, removal of all but a portion of one parathyroid may be indicated. Patients may have a quick decrease in the serum calcium level after surgery and may require treatment with calcium and or vitamin D if they become symptomatic.

Information on the Thyroid

This information is provided by the University of Michigan Department of Surgery, Section of Pediatric Surgery and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact your health care provider or our offices.