The purpose of putting pictures of parathyroid tumors here is so that patients and doctors can have a better appreciation for hyperparathyroidism (parathyroid disease). It is easier to understand hyperparathyroidism when you can see the actual parathyroid tumor which is making the excess PTH hormone. Remember, normal parathyroid glands are about the size of a grain of rice. Each of the parathyroid photos on this page are scaled to be the correct size--this is the size of the tumor we removed from these patient's necks (this is actual size if you have a 19" monitor... if your monitor is smaller, these tumors are much bigger).
As you read each of these cases of hyperparathyroidism, it is 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 10.4 --- 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. On some of these pictures you can see the small, yellow, normal parathyroid gland stuck on the edge of the big maroon adenoma. The parathyroid adenoma tumor grew out of the small normal gland. NOTE: There is important information for you to read at the bottom of the page... make sure you read it. Finally..... We have noted on some of the pictures a graphic Negative Scan which means that this patient had a negative sestamibi scan at their home town x-ray department prior to coming to our clinic. Thus 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! Note: all of our patients get a photo of their tumor... and their doctors get a photo too.
Parathyroid adenoma
Pre-op Calcium 10.9
Pre op PTH 83
Boca Raton, Florida
Adenoma = left, normal gland = right
Pre-op Calcium 11.3
Pre op PTH 79
Great Falls, Montana
Parathyroid adenoma
Pre-op Calcium 11.5
Pre op PTH 196
Toms River, New Jersey
Pre-op CA = 12.1
Pre-op PTH = 150
Seattle, Washington
Parathyroid adenoma
Pre-op Calcium 10.5
Pre op PTH 75
Reno, Nevada
Parathyroid adenoma
Pre-op Calcium 10.7
Pre op PTH 121
Los Angeles, California
Pre-op Calcium 10.5
Pre op PTH 101
Newman Lake, Washington
25 year old female
Parathyroid adenoma
Pre-op Calcium 11.2
Pre op PTH 115
Irving, Texas
Pre-op Calcium 11.4
Pre op PTH 159
Sarasota, Florida
65 year old female
Parathyroid adenoma
Pre-op Calcium 10.9
Pre op PTH 152
Mesa, Arizona
Parathyroid adenoma
Pre-op Calcium 10.9
Pre op PTH 141
Ft. Meyers, Florida
58 year old female
Parathyroid adenoma
Pre-op Calcium 11.2
Pre op PTH 74
Boynton Beach, Florida
63 year old male
Parathyroid adenoma
Pre-op Calcium 10.9
Pre op PTH 89
Nashville, Tennessee
49 year old male
Parathyroid adenoma
Pre-op Calcium 11.5
Pre op PTH 141
Los Angeles, California
Parathyroid adenoma
Pre-op Calcium 11.4
Pre op PTH 155
Houston, Texas
Pre-op Calcium 10.7
Pre op PTH 120
Clearwater, Florida
Parathyroid adenoma
Pre-op Calcium 11.1
Pre op PTH 102
St. Croix, US Virgin Islands
Parathyroid adenoma
Pre-op Calcium 10.8
Pre op PTH 94
West Palm Beach, Florida
(Never had a high PTH level)
Parathyroid adenoma
Pre-op Calcium 11.4
Pre op PTH 55
Torrance, California
Pre-op Calcium 10.8
Pre op PTH 126
Wausau, Wisconsin
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 140
Orlando, Florida
Parathyroid adenoma
Pre-op Calcium 11.6
Pre op PTH 108
St. Petersburg, Florida
Pre-op Calcium 11.8
Pre op PTH 147
Detroit, Michigan
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 71
Lake Forrest, Illinois
43 year old female
Parathyroid adenoma
Pre-op Calcium 10.1
Pre op PTH 91
Las Vegas, Nevada
Parathyroid adenoma
Pre-op Calcium 11.5
Pre op PTH 126
Tampa, Florida
53 year old female
Parathyroid adenoma
Pre-op Calcium 10.8
Pre op PTH 230
Vero Beach, Florida
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 138
Bradenton, Florida
Parathyroid adenoma
Pre-op Calcium 10.5
Pre op PTH 119
Lawrence, Kansas
Parathyroid adenoma
Pre-op Calcium 11.6
Pre op PTH 105
McAllen, Texas
62 year old female
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 108
Oklahoma City, Oklahoma
Parathyroid adenoma
Pre-op Calcium 11.3
Pre op PTH 97
Tucson, Arizona
Parathyroid adenoma
Pre-op Calcium 12.0
Pre op PTH 112
Tallahassee, Florida
Parathyroid adenoma
Pre-op Calcium 11.3
Pre op PTH 59
Las Vegas, Nevada
(never had a high PTH level)
74 year old female
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 101
Chicago, Illinois
Parathyroid adenoma
Pre-op Calcium 11.1
Pre op PTH 132
Boston, Massachusetts
Pre-op Calcium 11.7
Pre op PTH 103
Houston, Texas
Pre-op Calcium 12.0
Pre op PTH 82
Tampa, Florida
Parathyroid adenoma
Pre-op Calcium 10.7
Pre op PTH 118
Las Vegas, Nevada
Pre-op Calcium 10.6
Pre op PTH 75
Miami, Florida
Note how the big red tumor is growing out of a small, normal (yellow) parathyroid gland on the right side
Parathyroid adenoma
Pre-op Calcium 11.1
Pre op PTH 121
Phoenix, Arizona
Parathyroid adenoma
Pre-op Calcium 10.7
Pre op PTH 75
Dothan, Alabama
Pre-op Calcium 10.8
Pre op PTH 95
Sacramento, California
Parathyroid adenoma
Pre-op Calcium 10.7
Pre op PTH 71
Pompano Beach, Florida
Pre-op Calcium 10.9
Pre op PTH 103
Sarasota, Florida
Pre-op Calcium 10.9
Pre op PTH 95
Zephyrhills, Florida
Pre-op Calcium 10.8
Pre op PTH 92
Cincinnati, Ohio
Parathyroid adenoma
Pre-op Calcium 11.9
Pre op PTH 129
Marietta, Georgia
Parathyroid adenoma
Pre-op Calcium 12.0
Pre op PTH 317
Kilgore, Texas
Pre-op Calcium 10.5
Pre op PTH 118
Lake Worth, Florida
Parathyroid adenoma
Pre-op Calcium 10.9
Pre op PTH 71
Wayne, New Jersey
Parathyroid adenoma
Pre-op Calcium 11.1
Pre-op PTH 113
Venice, Florida
Pre-op Calcium 10.5
Pre-op PTH 51
Calgary, Alberta; Canada
Pre-op Calcium 10.5
Pre-op PTH 125
New York, New York
60 year old female
Parathyroid adenoma
Pre-op Calcium 11.3
Pre-op PTH 148
Bellevue, Washington
Pre-op Calcium 12.0
Pre-op PTH 335
Altamonte Springs, Florida
Parathyroid adenoma
Pre-op Calcium 11.7
Pre-op PTH 207
Lakeland, Florida
Parathyroid adenoma
Pre-op Calcium 10.6
Pre-op PTH 74
Atlanta, Georgia
Parathyroid adenoma
Pre-op Calcium 12.6
Pre-op PTH 117
West Palm Beach, Florida
55 year old female
Parathyroid Hyperplasia
Pre-op Calcium 11.3
Pre op PTH 116
Sanford, Florida
Note that this patient has 4-gland hyperplasia and NOT a single adenoma. Over 95% of patients have a single bad gland (an adenoma), whereas about 4% have 4-gland hyperplasia... where all four glands are enlarged. This patient was treated by removing the three largest glands and only 1/2 of the smallest gland.. still takes only about 21 minutes.
Parathyroid adenoma
Pre-op Calcium 10.8
Pre-op PTH 155
Winter Park, Florida
Parathyroid adenoma
Pre-op Calcium 10.8
Pre op PTH 104
Buffalo, New York
Parathyroid adenoma
Pre-op Calcium 11.1
Pre op PTH 38
St. Petersburg, Florida
(never had a high PTH level)
61 year old female
Parathyroid adenoma
Pre-op Calcium 11.9
Pre op PTH 180
Malaysia
Parathyroid adenoma
Pre-op Calcium 12.8
Pre op PTH 170
Boca Raton, Florida
(never had a high PTH level)
Parathyroid adenoma
Pre-op Calcium 11.4
Pre op PTH 60
Sanford, Florida
Parathyroid adenoma
Pre-op Calcium 10.5
Pre op PTH 73
Riverview, Florida
Parathyroid adenoma
Pre-op Calcium 12.3
Pre op PTH 143
Omaha, Nebraska
Pre-op Calcium 11.2
Pre op PTH 123
Fort Lauderdale, Florida
48 year old femalePre-op Calcium 11.3
Pre op PTH 115
Los Angeles, California
The drawing shows how a large tumor grew out of a small, normal parathyroid gland. All parathyroid adenomas are tumors that grow out of a normal parathyroid gland.
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 34
Sebring, Florida
IMPORTANT! Note that this patient's parathyroid hormone was NEVER elevated. Many people with hyperparathyroidism have high calcium levels and NORMAL PTH levels. Just because you have normal PTH levels does NOT mean you don't have hyperparathyroidism.
58 year old female
Parathyroid adenoma
Pre-op Calcium 11.4
Pre op PTH 67
Parathyroid adenoma
Pre-op Calcium 11.3
Pre op PTH 112
Melbourne, Florida
Pre-op Calcium 10.7
Pre op PTH 158
Oviedo, Florida
Parathyroid adenoma
Pre-op Calcium 12.7
Pre op PTH 196
Durham, North Carolina
Pre-op PTH = 435
Las Vegas, Nevada
Parathyroid adenoma
Pre-op Calcium 12.0
Pre op PTH 187
Venice, Florida
76 year old female
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 110
Tampa, Florida
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 86
Gatlinburg, Tennessee
Parathyroid adenoma
Pre-op Calcium 11.6
Pre op PTH 79
Bronx, New York
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 87
San Antonio, Texas
Pre-op Calcium 12.3
Pre op PTH 166
Phoenix, Arizona
Parathyroid adenoma
Pre-op Calcium 11.5
Pre op PTH 173
Zephyrhills, Florida
NOTE: This is a "double adenoma", this patient had TWO bad glands... not very common!
Parathyroid adenoma
Pre-op Calcium 11.3
Pre op PTH 53
Jacksonville, Florida
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 77
Sacramento, California
60 year old female
Parathyroid adenoma
Pre-op Calcium 11.3
Pre op PTH 140
Seattle, Washington]
Parathyroid adenoma
Pre-op Calcium 11.4
Pre op PTH 199
Hong Kong, China
53 year old female
Parathyroid adenoma
Pre-op Calcium 10.7
Pre op PTH 78
Columbus, Ohio
Parathyroid adenoma
Pre-op Calcium 11.1
Pre op PTH 80
Ocala, Florida
Parathyroid adenoma
Pre-op Calcium 10.8
Pre op PTH 65
Boynton Beach, Florida
65 year old female
Parathyroid adenoma
Pre-op Calcium 11.0
Pre op PTH 99
Saint Louis, Missouri
55 year old female
Parathyroid adenoma
Pre-op Calcium 10.7
Pre op PTH 102
Brooklyn, New York
Parathyroid adenoma
Pre-op Calcium 12.1
Pre op PTH 284
Baltimore, Maryland
Parathyroid adenoma
Pre-op Calcium 11.5
Pre op PTH 77
Nantucket, MA
63 year old male
Parathyroid adenoma
Pre-op Calcium 10.4
Pre op PTH 143
Deerfield Beach, Florida
This is a case of TERTIARY hyperparathyroidism (occurs after a kidney transplant). This is hyperplasia of all four glands (NOT 4 adenomas), treated by removal of the 3 largest tumors and about 1/2 of the smallest.
Parathyroid adenoma
Pre-op Calcium 11.1
Pre op PTH 104
Bonanza, Oregon
Parathyroid adenoma
Pre-op Calcium 11.7
Pre op PTH 83
Aspen, Colorado
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 120
Boston, Massachusetts
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 80
Overland, Kansas
Parathyroid adenoma
Pre-op Calcium 10.6
Pre op PTH 120
Boston, Massachusetts
63 year old female
Parathyroid Double Adenoma
Pre-op Calcium 11.1
Pre op PTH 203
Aurora, Missouri
Parathyroid adenoma
Pre-op Calcium 10.9
Pre op PTH 60
Rochester, Minnesota
49 year old female
Parathyroid adenoma
Pre-op Calcium 10.2
Pre op PTH 142
Wantage, New Jersey
IMPORTANT CONCEPTS TO GRASP FROM THIS PAGE OF PARATHYROID.COM
As you read this page, you need to grasp several concepts: 1) Normal parathyroid glands are very small. 2) Only 70% of patients with parathyroid disease will have one bad parathyroid gland and three small normal glands, 30% will have more than one! Thus you should demand that your surgeon looks at all four. 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 (clearly one of the most important points of this entire page, 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. Look at the size of the tumors in people who have calcium levels above 12... these tumors take serious tolls on people's lives as they sit in the neck and grow for years. Don't do that! 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 (65% of the time), or that the tumor is small and hiding behind the thyroid (35% 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. All of these tumors with the Negative Scan graphic on them had a "negative" sestamibi scan at their home town x-ray department... but when we did the scan correctly, the scan was positive and we can see the tumor. Most scans are done poorly and are negative because they are poor quality scans! 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 (we do mini surgery on 100% of patients and wish nobody had a scan ahead of time... it just confuses things! Yes... we do mini surgery even if the scan is negative). 9) All patients should have all four parathyroid glands examined by your surgeon, or he/she will miss a second tumor in 25-30% of you. Watch the video of Dr Norman performing this operation... the scan shows one tumor in this man and when Dr Norman checks the other three he finds a second tumor! This video is one of the most important lessons on this large website.
MISTAKES BEING MADE IN THE DIAGNOSIS AND TREATMENT OF HYPERPARATHYROIDISM
This page also serves to show the two most common misconceptions and misunderstandings that many doctors have about hyperparathyroidism. Most doctors who don't see patients with hyperparathyroidism very often will believe that to make the diagnosis of hyperparathyroidism it is required 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 our last 3000 patients did not have high calcium and high PTH at the same time... some of them are on this page). In our opinion, 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 11 or 12 as the number where the patient should finally get an operation). Geeeezzzzz! PLEASE look at this page and look at the size of the tumors in these patients' necks who have calcium levels above 12! Heck, look at the size of the tumors that people have who have calcium levels of 10.5. What are we waiting for? 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. Get rid of it! If you are told to wait for surgery until your calcium is some number that is picked out of thin air (or obtained from some out-dated "guideline"), then please print this page and discuss it with your doctor. We believe this is a very serious mistake.
The height of the calcium has nothing to do with the disease severity. How many problems you have from hyperparathyroidism (osteoporosis, A-Fib, high blood pressure, kidney stones, kidney failure, stroke, MGUS, GERD, etc, are due to the duration of elevated calcium (over 10.0 mg/dl for adults in the US, and over 2.52 mmol/L in Europe). Time is the enemy. How long it has been high is the problem, not how high it is. Thus "waiting" and "observing" is always the wrong thing to do.
One final note. We provide our patients with a photograph of their parathyroid tumor for a number of reasons, primarily educational (which is why we send a copy to your doctors). We also have found that these photos are helpful when patients have to deal with insurance companies who deny them coverage. Life insurance companies know your life expectancy is decreased when you have a parathyroid tumor in your neck, so they may deny you coverage. Click here to learn more about this. The good news is that when the parathyroid tumor is removed the parathyroid disease is cured.
This page was last updated: 12/20/2015