Raised calcium is a common but often under-investigated finding. For many patients, it is the cause of years of debilitating symptoms — and the treatment is straightforward. Mr Smellie offers expert assessment and parathyroid surgery at Cleveland Clinic London.
Hypercalcaemia — raised calcium in the blood — is detected on routine blood testing in a significant number of patients each year. Despite being common, many patients go without a clear diagnosis for months or even years, continuing to experience symptoms that significantly affect their day-to-day quality of life.
The most common cause is primary hyperparathyroidism — an overactive parathyroid gland, usually caused by a benign adenoma. The parathyroid glands are four small glands in the neck that regulate calcium levels. When one becomes overactive, calcium rises — and stays raised — causing a constellation of symptoms that can be mistaken for depression, chronic fatigue, fibromyalgia, or simply "getting older."
The key diagnostic step is simple: if calcium is raised, PTH should be measured. A PTH that is elevated — or even within the normal range but detectable in the context of a high calcium — points strongly towards primary hyperparathyroidism and warrants specialist assessment.
Highlighted symptoms are those most commonly reported as most quality-of-life impairing.
Parathyroidectomy — surgical removal of the overactive parathyroid gland — is the only curative treatment for primary hyperparathyroidism. Mr Smellie offers both targeted minimally invasive surgery and traditional four-gland exploration. Patients may specify their preference, or discuss with the team which approach best suits their individual case based on pre-operative imaging and biochemistry.
Where pre-operative imaging has identified a single overactive gland, a targeted approach allows removal through a small focused incision. Intraoperative PTH monitoring (IOPTH) provides real-time confirmation that the correct gland has been removed — PTH falls by more than 50% within minutes of successful excision, giving high confidence of cure without the need for full neck exploration.
The traditional and definitive approach — all four parathyroid glands are identified and assessed at surgery. This is particularly appropriate where pre-operative imaging is inconclusive or negative, where multiglandular disease is suspected (e.g. in MEN syndromes), or where a patient specifically requests it for the added reassurance of a complete assessment. IOPTH can also be used during four-gland exploration.
Intraoperative PTH monitoring (IOPTH) is one of the most important advances in parathyroid surgery. PTH has a very short half-life — approximately 3–5 minutes. This means that if the overactive gland is successfully removed, PTH levels in the blood fall rapidly and measurably within minutes of excision, providing real-time biological confirmation of cure in the operating theatre.
A drop of more than 50% from the pre-excision baseline, combined with normalisation into the reference range, is the accepted criterion for a successful operation — the Miami Criterion — and allows the surgeon to close with confidence that the correct gland has been removed.
Mr Smellie treats many patients at Cleveland Clinic London who have a confirmed or suspected diagnosis of primary hyperparathyroidism but are not prepared to remain untreated on NHS waiting lists — and who value the prompt, personal and internationally excellent care that Cleveland Clinic London provides.
Mr Smellie offers prompt assessment and expert parathyroid surgery at Cleveland Clinic London.
Same-week appointments available. Insured and self-pay patients welcome.