Nobody really knows why the parathyroid glands should be placed so close to the thyroid. Perhaps to challenge the dexterity of thyroid surgeons.
Four parathyroids about the size of a pea each, embrace the thyroid. Their small size belies their importance, as many a thyroid patient will testify when the tingles and the cramps set in the day after the thyroid operation.
Luckily, parathyroids are a bit like footballers, they collapse after a gentle push by the opposition, but can recover miraculously with some encouragement.
So, what do the parathyroids do? Their purpose in life is to keep the calcium level in the blood normal.
When they give up, calcium drops and the typical symptoms appear: cramps and tingling, usually in the fingertips, toes and around the lips.
To treat it, we give calcium tablets and a form of vitamin D (alfacalcidol or calcitriol), which control the symptoms very effectively. That is all fine, but this treatment needs regular monitoring, as occasionally the blood calcium level will go too high and that can cause problems to kidneys.
So much happens in the first 12 months after the diagnosis of thyroid cancer, that perhaps it’s not a surprise that many thyroid patients carry on taking the calcium pills for ever after without questioning the need to do so. For many patients it is possible to reduce the number or dose of medication for control of calcium, and in some cases come off them altogether. This however needs to be done under the supervision of a doctor or specialist nurse. Even small reductions in the dose of the pills can bring back the tingling and the cramps. However perseverance usually will reward you with the freedom of not having to take so many pills.