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Hyperparathyroidism

What is hyperparathyroidism?

Hyperparathyroidism occurs when one or more of your parathyroid glands are overactive. You have 4 of these tiny glands. Each one is about the size of a pea. They are found in your neck, behind the thyroid gland. These glands make parathyroid hormone (PTH) that regulates calcium, phosphorus, and vitamin D levels in your blood. Magnesium levels are important for correct functioning of the parathyroid glands. If these glands are overactive, they make too much PTH. That raises the level of calcium in your blood.

PTH causes calcium to be released from your bones. This loss of calcium from the bones can lead to weak, brittle bones (osteopenia and osteoporosis), and bone fractures. When the blood with this high calcium goes through the kidneys, the calcium may be filtered into the urine. That can lead to kidney stones.

What causes hyperparathyroidism?

Hyperparathyroidism most often happens when one of your parathyroid glands gets larger or has a tumor on it. The gland then makes too much parathyroid hormone. Most people with this problem have 1 abnormal gland. Some people may have 2 abnormal glands. A small number of people have 4 abnormal glands. Having 4 abnormal glands is rare. It is often a genetic problem. In most cases, if a tumor is causing the gland to be overactive, the tumor is not cancer (benign). In rare cases, the tumor may be cancer.

Who is at risk for hyperparathyroidism?

You may be more likely to have hyperparathyroidism if:

  • You are a woman who has already gone through menopause
  • You have a family history of related conditions
  • You have had radiation therapy on your head and neck
  • You have taken medicines, such as lithium, a medicine used to treat bipolar disorder, or certain diuretics (water pills)
  • You have a decreased level of vitamin D
  • You have malabsorption problems

What are the symptoms of hyperparathyroidism?

Each person may have symptoms in a different way. But these are the most common symptoms (due to hypercalcemia):

  • Joint aches and pains

  • Muscle weakness

  • Depression

  • Belly (abdominal) pain

  • GERD (gastroesophageal reflux disease)

  • Peptic ulcer disease

  • Pancreatitis

  • Severe tiredness (fatigue)

  • Memory impairment

  • Urinating more than normal

  • Increased thirst

  • Loss of appetite

  • Confusion

  • Osteoporosis

  • Kidney stones

These symptoms may look like other health problems. Always see your healthcare provider for a diagnosis.

How is hyperparathyroidism diagnosed?

A blood test can often find hyperparathyroidism. It can spot high levels of calcium and parathyroid hormone. Genetic testing may be suggested if hyperparathyroidism runs in your family. You may also need a urine test. This can measure the calcium in your urine over 24 hours.

How is hyperparathyroidism treated?

Treatment will depend on the cause, your symptoms, age, and general health. It will also depend on how severe the condition is.

Treatment options

  • Surgery. If your case is more severe, your parathyroid gland may need to be removed. Before surgery, you may have an imaging test to find out which gland is abnormal. You may also have an ultrasound of the neck. Knowing which gland is abnormal will shorten the surgery. It will also allow the surgeon to make a smaller cut (incision) right over the abnormal gland.
  • Monitoring. If you condition is mild, your healthcare provider may closely keep track of your condition to make sure it doesn’t get worse.
  • Medicines. Your healthcare provider may prescribe medicines, such as cinacalcet in specific cases.

Living with hyperparathyroidism

You will likely need to have your calcium and vitamin D levels and bone density checked from time to time. Your healthcare provider will then be able to make sure your problem is under control.

When should I call my healthcare provider?

Tell your healthcare provider if your symptoms get worse or you have new symptoms.

Key points about hyperparathyroidism

  • Hyperparathyroidism happens when one or more of your parathyroid glands are overactive. The glands make too much parathyroid hormone. That raises the level of calcium in your blood. It then lowers the calcium in your bones.
  • It most often happens when a parathyroid gland gets larger or has a tumor on it. It may also be due to a genetic problem.
  • The loss of calcium from the bones can lead to weak, brittle bones (osteopenia and osteoporosis) and bone fractures.
  • A routine blood test can spot high levels of calcium.
  • The treatment will depend on the cause and symptoms. Treatment options are keeping track of the condition, taking medicines, or having surgery to remove the abnormal gland.

Next steps

Tips to help you get the most from a visit to your healthcare provider:

  • Know the reason for your visit and what you want to happen.
  • Before your visit, write down questions you want answered.
  • Bring someone with you to help you ask questions and remember what your provider tells you.
  • At the visit, write down the name of a new diagnosis, and any new medicines, treatments, or tests. Also write down any new instructions your provider gives you.
  • Know why a new medicine or treatment is prescribed, and how it will help you. Also know what the side effects are.
  • Ask if your condition can be treated in other ways.
  • Know why a test or procedure is recommended and what the results could mean.
  • Know what to expect if you do not take the medicine or have the test or procedure.
  • If you have a follow-up appointment, write down the date, time, and purpose for that visit.
  • Know how you can contact your healthcare provider if you have questions.