Hyperparathyroidism
What is Hyperparathyroidism?
Hyperparathyroidism is a condition where your parathyroid glands make too much parathyroid hormone. The four parathyroid glands are tiny organs in your neck, located behind the thyroid gland. Their main job is to control calcium levels in your blood and bones.
When these glands become overactive, they release excess parathyroid hormone into your bloodstream. This causes calcium to leave your bones and enter your blood. High calcium levels can affect many parts of your body, including your kidneys, bones, digestive system, and brain.
There are two main types of hyperparathyroidism. Primary hyperparathyroidism happens when one or more parathyroid glands develop a problem and produce too much hormone. Secondary hyperparathyroidism occurs when another condition, like kidney disease or vitamin D deficiency, causes the glands to work overtime.
Symptoms
- Kidney stones that may cause pain and blood in urine
- Bone pain, weakness, or fractures that happen easily
- Fatigue and feeling tired most of the time
- Depression, mood changes, or memory problems
- Nausea, vomiting, or loss of appetite
- Frequent urination and constant thirst
- Stomach pain or constipation
- Muscle weakness, especially in the legs
- Confusion or difficulty concentrating
Many people with mild hyperparathyroidism have no symptoms at all. The condition is often discovered by chance during routine blood work. Some people live with the condition for years before it causes noticeable problems.
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Causes and risk factors
Primary hyperparathyroidism is usually caused by a benign tumor called an adenoma growing on one of the parathyroid glands. In rare cases, cancer of the parathyroid gland can cause the condition. Some people develop enlargement of all four glands, a condition called hyperplasia. Genetics play a role in some cases, particularly in people with certain hereditary syndromes. Women over 60 are at highest risk for developing primary hyperparathyroidism.
Secondary hyperparathyroidism develops when your body faces a chronic shortage of calcium or vitamin D. This often happens in people with kidney disease who cannot properly activate vitamin D. When calcium levels drop, your parathyroid glands respond by working harder to restore balance. Over time, this constant stimulation causes the glands to grow larger and produce excess hormone. Other risk factors include certain medications, severe calcium deficiency, and conditions that prevent calcium absorption from food.
How it's diagnosed
Hyperparathyroidism is typically diagnosed through blood tests that measure calcium levels and parathyroid hormone. Doctors look for elevated calcium alongside high or inappropriately normal parathyroid hormone levels. Additional blood tests may check vitamin D levels, alkaline phosphatase, and markers of bone turnover like C telopeptide. Ionized calcium tests can help confirm the diagnosis by measuring the active form of calcium in your blood.
Your doctor may also order urine tests to measure how much calcium your kidneys are filtering. Imaging tests like ultrasound or nuclear medicine scans can help locate abnormal parathyroid tissue. Bone density scans may reveal bone loss caused by the condition. Talk to a doctor about which tests are right for your situation, as specialized testing may be needed for accurate diagnosis.
Treatment options
- Surgery to remove the overactive parathyroid gland or glands is the most common treatment for primary hyperparathyroidism
- Monitoring with regular blood tests and bone density scans if symptoms are mild and calcium levels are only slightly elevated
- Drinking plenty of water to prevent kidney stones and help flush excess calcium
- Staying physically active with weight-bearing exercise to protect bone strength
- Avoiding thiazide diuretics and lithium, which can worsen calcium levels
- Calcimimetic medications like cinacalcet that help lower calcium levels in people who cannot have surgery
- Treating underlying vitamin D deficiency carefully under medical supervision
- Managing secondary hyperparathyroidism by addressing kidney disease and correcting vitamin D levels
- Bisphosphonate medications to protect bones in people who are not surgical candidates
Frequently asked questions
Primary hyperparathyroidism occurs when one or more parathyroid glands develop a problem and make too much hormone on their own. Secondary hyperparathyroidism happens when another condition, like kidney disease or vitamin D deficiency, forces the parathyroid glands to work overtime to maintain calcium balance. The treatment approach differs significantly between these two types.
Primary hyperparathyroidism rarely goes away without treatment. The condition is usually caused by a benign tumor that continues to produce excess hormone until it is removed. Secondary hyperparathyroidism may improve if the underlying cause, like vitamin D deficiency or kidney disease, is successfully treated. Most people with primary hyperparathyroidism eventually need surgery.
Hyperparathyroidism can range from mild to serious depending on calcium levels and symptoms. Untreated cases can lead to kidney stones, osteoporosis, fractures, and kidney damage over time. Some people have mild cases that remain stable for years with monitoring. Early detection through blood tests helps prevent serious complications.
In hyperparathyroidism, blood calcium levels rise above normal while calcium is pulled out of your bones. This happens because excess parathyroid hormone signals your bones to release calcium into the bloodstream. High blood calcium can cause symptoms like fatigue, kidney stones, and confusion. Over time, this calcium loss weakens your bones and increases fracture risk.
Parathyroid surgery is generally safe with an experienced surgeon. The procedure typically takes 1 to 2 hours and most people go home the same day. Cure rates exceed 95 percent when performed by specialists. Risks include temporary voice changes, low calcium after surgery, and rare damage to surrounding structures.
The main blood tests include calcium, ionized calcium, and parathyroid hormone levels. Doctors also check vitamin D levels, alkaline phosphatase, and bone turnover markers like C telopeptide. Elevated calcium with high or inappropriately normal parathyroid hormone strongly suggests hyperparathyroidism. Your doctor may repeat tests to confirm the diagnosis before recommending treatment.
Diet alone cannot cure hyperparathyroidism, but it can help manage symptoms. Drinking plenty of water helps prevent kidney stones. Getting adequate calcium from food is important, as restricting calcium can actually worsen parathyroid hormone levels. Avoiding excess vitamin D supplements without medical guidance is also important, as they can raise calcium levels further.
Untreated hyperparathyroidism can lead to severe osteoporosis and bone fractures. Kidney stones may develop repeatedly and cause permanent kidney damage. Some people experience worsening cognitive problems, depression, and quality of life issues. High calcium levels can rarely cause dangerous heart rhythm problems and extreme fatigue.
People with mild hyperparathyroidism who are not having surgery need blood tests every 6 to 12 months. Your doctor will monitor calcium, kidney function, and vitamin D levels. Bone density scans are typically done every 1 to 2 years. More frequent testing may be needed if calcium levels rise or symptoms develop.
Hyperparathyroidism does not directly cause weight gain. However, the fatigue and muscle weakness it causes may make it harder to stay active. Some people gain weight as a result of reduced physical activity. Others lose weight due to nausea and digestive symptoms. Weight changes vary significantly from person to person.