Cancer of the parathyroid glands

The parathyroid glands make a chemical called parathyroid hormone (PTH). This helps control calcium levels in the blood. If these glands are enlarged or affected by a tumour, they often produce too much PTH. This causes high levels of calcium in the blood (hypercalcaemia) with symptoms such as:

  • feeling thirsty and passing a lot of urine
  • tiredness
  • feeling or being sick
  • mood changes
  • tummy or back pain
  • indigestion
  • loss of appetite
  • constipation
  • muscle weakness.

You may have blood and urine tests, and scans to check your parathyroid glands.

The main treatment is surgery to remove any abnormal glands. These can then be examined under a microscope for signs of cancer. Parathyroid cancer is rare. The glands are usually non-cancerous (benign).

Surgery can also be used if a cancer comes back again or spreads. Radiotherapy and radiofrequency ablation are sometimes used. You may also have other treatments, such as drugs to control the level of calcium in your blood.

You will have regular check-ups and blood tests after treatment is over. These will probably continue for several years.

The parathyroid glands

Tumours in the parathyroid glands are usually non-cancerous (benign). Rarely, a parathyroid gland tumour is cancer. This information is about cancer of the parathyroid glands.

We also have information about thyroid cancer, which is a different type of cancer and is treated differently.

Position of the parathyroid glands
Position of the parathyroid glands

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There are four small parathyroid glands near the thyroid gland in the front of the neck. Although the thyroid gland and the parathyroid glands are close to each other and have similar names, they are different and do different things.

Parathyroid glands are part of the endocrine system. This system makes chemicals called hormones, which help control many of the body’s functions.

Parathyroid glands make parathyroid hormone (PTH), which helps control calcium levels in the blood. Calcium helps your muscles and nerves work, builds strong bones and helps your blood clot.

Most of the calcium in the body is stored in the bones. PTH makes the bones release calcium into the blood. When calcium levels in the blood are high, the parathyroid glands produce less PTH and calcium levels drop.

Causes and risk factors for parathyroid cancer

We do not know what causes parathyroid cancer in most people. People who have genetic conditions such as hyperparathyroidism-jaw tumour syndrome (HPT-JT) or familial hyperparathyroidism may have a higher risk of developing parathyroid cancer. These are rare conditions caused by a gene change (mutation) passed on from parent to child (inherited).

Signs and symptoms of parathyroid cancer

The symptoms of parathyroid cancer are the same as for other common parathyroid conditions such as benign tumours or enlarged parathyroid glands.

The parathyroid gland makes too much PTH. This causes high levels of calcium in the blood (hypercalcaemia).

Common symptoms of hypercalcaemia include:

  • feeling thirsty and passing lots of urine
  • tiredness
  • feeling sick and being sick (vomiting)
  • changes in mood – feeling low, depressed, irritable or nervous
  • pain in the tummy or back
  • indigestion
  • loss of appetite
  • constipation
  • muscle weakness.

If it is not treated, hypercalcaemia can cause bone thinning due to loss of calcium from the bones. This can lead to bone damage and pain.

High calcium levels in the blood can affect the kidneys. Some people develop kidney stones, or their kidneys may become damaged and not work as well.

Sometimes people with a parathyroid tumour have a lump or swelling in their neck. This can cause difficulty swallowing and hoarseness.

Diagnosing parathyroid cancer

You usually start by seeing your GP, who will examine you and ask about your symptoms and general health. Your GP may arrange tests. If they think that your symptoms could be caused by a parathyroid condition, they will refer you to a hospital specialist to be assessed.

The following tests may show that the parathyroid glands are producing too much PTH or that they look abnormal. But these tests do not usually show if this is because of cancer or another condition.

If tests show that the glands are abnormal, treatment is usually an operation to remove them. After surgery, the glands are examined carefully under a microscope to find out more. In most cases, a non-cancerous (benign) tumour is found. Rarely, cancer is found and you may have further tests to check if any other areas of the body have been affected.

Parathyroid tests

Blood and urine tests

You will have blood and urine tests to check your calcium and PTH levels. For the urine test, your doctor may ask you to collect all the urine you pass in 24 hours. For some blood tests, the doctor will ask you not to eat (fast) overnight before they take the sample. You should follow any instructions carefully to get clear results.

Ultrasound scan

This test uses sound waves to build up a picture on a computer screen of the parathyroid glands and other structures in the neck. Ultrasound is painless and only takes a few minutes. The person doing the scan puts some gel on your neck. They then move a small device, which produces sound waves, over the skin.

Parathyroid scan (sestamibi scan)

This scan shows the position of the parathyroid glands and any abnormal areas.

To have the scan, you visit the hospital scanning department twice on the same day. On the first visit, you have an injection of a slightly radioactive liquid called sestamibi. The radiation dose is low and very unlikely to harm you. Before the scan, tell your doctor or staff in the scanning department if you are, or think you could be, pregnant. You should also tell them if you are breastfeeding.

The person doing the scan gives the injection into a vein in your arm. You then wait for about 10 minutes for it to travel through your blood to your parathyroid glands. A special camera is then used to take pictures of your neck. You need to lie still for about 40 minutes while this happens. The camera is positioned close to your head. Tell your doctor or the staff doing the scan if you think you might not be able to lie still or if you have difficulty being in closed spaces (claustrophobia).

After this, you can leave the scanning department for a few hours. The staff will tell you when to come back for the final scans. These may take another 30 to 40 minutes.

You should avoid close contact with pregnant women and very young children for 24 hours after this type of scan. This is because during this time your body will give off a small amount of radioactivity. The staff doing the scan can tell you more about this.

Further tests

These tests can be used to look for signs of cancer that has spread outside the parathyroid glands. You may have these after surgery if cancer has been found or if your doctor thinks other tests show that there is a higher chance of cancer.

CT (computerised tomography) scan

A CT scan takes a series of x-rays that build up a three-dimensional (3D) picture of the inside of the body. It is painless and takes 10 to 30 minutes. It uses a small amount of radiation, which is very unlikely to harm you or anyone you come into contact with.

You will be asked not to eat or drink for at least four hours before the scan.

You may be given a drink or injection of a dye that allows particular areas to be seen more clearly. This may make you feel hot all over for a few minutes. It is important to let your doctor know if you are allergic to iodine or have asthma, because you could have a more serious reaction to the injection.

MRI (magnetic resonance imaging) scan

This test uses magnetism to build up a detailed picture of areas of your body. Before the scan you may be asked to complete and sign a checklist. This is to make sure it is safe for you to have the MRI scan. Before the scan, you will be asked to remove metal belongings including jewellery. Some people are given an injection of dye into a vein in the arm. This is called a contrast medium and can help the images from the scan to show up more clearly. During the test, you will be asked to lie very still on a couch inside a long cylinder (tube) for about 30 minutes. It is painless but can be slightly uncomfortable, and some people feel a bit claustrophobic. It is also noisy, but you will be given earplugs or headphones.

Staging parathyroid cancer

For parathyroid cancer, staging describes if the cancer has spread to nearby areas or to other parts of the body. Your doctor may describe the stage as localised or metastatic:

  • Localised – the cancer is in a parathyroid gland. It may have spread to nearby areas such as the thyroid, gullet, the nerve for the voice box (laryngeal nerve), or nearby muscle.
  • Metastatic – the cancer has spread to other parts of the body, such as the lymph nodes, lungs, liver or bones. This is also called advanced cancer.

Treating parathyroid cancer

Your care will be organised by a team of specialists with experience in managing endocrine tumours. This multidisciplinary team (MDT) will often include:

  • an endocrinologist – a doctor who specialises in treating disorders of the endocrine system
  • a surgeon who specialises in operating on endocrine glands
  • a cancer doctor (oncologist) who specialises in treating endocrine cancers
  • a radiologist – a specialist in x-rays and scans
  • a nuclear medicine physician – a specialist in scans
  • a pathologist – a doctor who specialises in examining changes in cells to diagnose tumours
  • a specialist endocrine nurse who can give you support and information.

The main treatment for parathyroid cancer is surgery. It is often the only treatment needed. Surgery can also be used to treat cancer that comes back again or if the cancer spreads to other areas of the body.

Rarely, radiotherapy is used to reduce the risk of cancer coming back after surgery. You may also have other treatments to control the level of calcium in your blood.


The surgeon removes the cancer and any nearby affected areas. They will remove one or more of the parathyroid glands, and part or all of the thyroid gland. They may also remove nearby lymph nodes. The lymph nodes are part of your body’s system to protect you from infection and disease. Sometimes cancer can spread from the parathyroid gland to nearby lymph nodes. You will usually have a general anaesthetic for surgery and will need to stay in hospital for a few days.

Surgery may also be used to remove cancer that has come back in the neck area or cancer that has spread, for example to the lungs or liver. Your specialist can give you more information about these types of operation.

After parathyroid gland surgery

The calcium levels in your blood may take two or three days to go back to normal after surgery. You will have regular blood tests to check the calcium levels. If the level is too low, your doctor will prescribe extra calcium as an injection into a vein (intravenously) or as tablets. You may also be prescribed Vitamin D supplements to help your body absorb calcium.

You will have some scars on your neck after the operation. These usually fade as they heal. Rarely, surgery causes damage that may affect the voice or breathing. Before you go home, your doctor will examine you carefully. Let them know if you notice any problems with your voice or breathing, as you may need further treatment.


Radiotherapy is not often used to treat parathyroid cancer. But you may have it after surgery to reduce the risk of the cancer coming back.

This treatment uses high-energy rays to destroy cancer cells. You have treatment in small doses (called fractions) over a few weeks, from a radiotherapy machine that is similar to an x-ray machine. It does not make you radioactive.

Side effects of radiotherapy

You may develop side effects during radiotherapy. These usually disappear gradually over a few weeks or months after treatment finishes. Your radiotherapy team will let you know what to expect. Tell them about any side effects you have. There are often things that can be done to help.

Your skin may become sore, dry and red (or darker if you have dark skin) in the area being treated. Your radiotherapy team will give you advice about skin care during treatment.

Your throat may become sore after a couple of weeks of treatment. This can affect eating and your voice may also become hoarse. You will be given help and support to cope with this.

We have more information about radiotherapy and coping with side effects.

Radiofrequency ablation

This treatment is sometimes used to treat parathyroid cancer that has spread to the liver. It uses heat to destroy cancer cells and helps to reduce the level of parathyroid hormone being made in the body.

Your doctor will give you a local anaesthetic and sedation before the treatment begins. In some cases, a general anaesthetic is used instead. Your doctor will place a needle into the tumour. This is usually done using a CT scanner to make sure the needle is in the right place. The doctor then passes radio waves down the needle into the tumour, to heat and destroy the cancer cells.

There are few side effects with this treatment, although you may have some discomfort or tiredness afterwards. You will usually need to stay in hospital overnight.

Clinical trials

Cancer research trials are carried out to try to find new and better treatments for cancer. Trials that are carried out on patients are known as clinical trials.

Research into treatments for parathyroid cancer is ongoing and advances are being made. But because it is a rare type of cancer, there may not always be a trial in progress. If there is, you may be asked to take part. Your doctor must discuss the treatment with you so that you have a full understanding of the trial and what it means to take part. You may decide not to take part or to withdraw from a trial at any stage. You will still receive the best standard treatment available.

Treating hypercalcaemia

If the levels of calcium in your blood are high, you may be given drugs to control this. You may take these as tablets or capsules. Some people will stay in hospital for a short while, to have the drugs as a drip (infusion) into a vein.

You may have treatment to lower your calcium levels before surgery. If the cancer has spread or can’t be removed with surgery, you may need ongoing treatment to control hypercalcaemia.

The following drugs may be given:

Bisphosphonates and denosumab

Most of the calcium in your body is stored in your bones. Bisphosphonates are drugs that stop the bones releasing calcium into the blood.

Some types of bisphosphonate are given as a drip into a vein. You can usually have this treatment as an outpatient. It takes 15 to 60 minutes and is usually given every three or four weeks.

Bisphosphonates can also be taken as tablets or capsules. If you are prescribed these, your doctor, nurse or pharmacist will explain how you should take them.

Sometimes bisphosphonate treatment is given with a new drug called denosumab. This is given as an injection just under the skin (subcutaneous injection).

We have more information about different types of bisphosphonates.

Drugs that reduce PTH production (calcimimetic agents)

These drugs work by reducing the amount of PTH (the hormone that raises blood calcium levels) made in the body. This helps to reduce calcium levels in the blood. The most commonly used drug of this type is a tablet called cinacalcet (Mimpara®).

Calcitonin (Miacalcic®)

This drug is given as a drip into a vein or as an injection under the skin. It is sometimes used to get very high levels of calcium under control if you are in hospital.


You will have regular check-ups and blood tests once your treatment has finished. These will probably continue for several years.

If you have any problems or notice any symptoms between these times, let your doctor know as soon as possible.

More support and information

Cancer in the parathyroid gland is rare and it can be difficult to know where to get information and support. If you want to talk to someone about this, call our cancer support specialists free on 0808 808 00 00 (Monday to Friday, 9am–8pm).

Sometimes it helps to talk to other people in a similar position. Our online community is a good place to meet people who are affected by cancer. It is quick and easy to join. You can talk to people in our chat rooms, blog your experiences, make friends and join support groups.