Hyperparathyroidism

Condition Basics

What is hyperparathyroidism?

Hyperparathyroidism means that one or more of your four parathyroid glands may be too active. These are tiny glands in the neck, behind the thyroid gland. When they're too active, they make too much parathyroid hormone (PTH). This hormone helps control how much calcium is in your blood.

When a parathyroid gland makes too much PTH, the amount of calcium in your blood goes up. Some of this calcium comes from your bones. That means that hyperparathyroidism can lead to weak bones and a greater risk of broken bones. The extra calcium in the blood can also lead to kidney stones and other health problems.

What causes it?

Hyperparathyroidism often is caused by a growth on one or more parathyroid glands, or by enlarged glands. In some cases, it runs in families. It can also be caused by certain health conditions or medicines. For example, it can be caused by chronic kidney disease or the medicine lithium.

What are the symptoms?

Most people with hyperparathyroidism have no symptoms when they're diagnosed. But when it does cause symptoms, they can include:

• Weak muscles.
• Feeling very tired or needing to sleep more than usual.
• Depression.
• Aches and pains in the bones and joints.
• Poor appetite.
• Nausea and vomiting.
• Constipation.
• Confusion and problems with memory.
• Feeling thirsty and having to urinate more than usual.

How is it diagnosed?

Your doctor does a blood test to check your parathyroid hormone (PTH) level. A high level of PTH is the main sign of this condition.

A routine blood test showing a high calcium level is often the first sign of hyperparathyroidism.

Routine checkups

When you have hyperparathyroidism, it's important to have regular checkups. Tests can include:

• Blood tests of your calcium and PTH levels to see if your condition is the same or getting worse.
• DXA tests. The DXA is an X-ray test that measures bone density. It is used to see if your bones are getting thin and brittle, which means they could break more easily.
• Urine tests to see if your kidneys are being affected and if they might form kidney stones.
• Imaging tests to look for kidney problems.

How is hyperparathyroidism treated?

Treatment for hyperparathyroidism depends on how mild or severe it is. It also depends on what you and your doctor decide is right for you.

Treatment options include:

Watchful waiting.

In mild cases, when there are no symptoms from high calcium and the calcium level is not very high, a doctor may suggest watchful waiting. That means doing regular tests to look for signs that hyperparathyroidism is getting worse or causing other health problems and needs more treatment.

Surgery.

When hyperparathyroidism is causing health problems from high calcium levels, doctors usually recommend surgery. Removing the problem parathyroid gland(s) is the only treatment that can cure this condition. Surgery can also be an option for people who don't yet have symptoms but are concerned about possible bone or kidney problems in the future.

While medicine can't cure hyperparathyroidism, it may help with symptoms from high calcium or with bone strength. If you can't have surgery for a medical reason, talk to your doctor about medicine for better bone strength or for lowering your calcium levels.

Each treatment choice has its own risks and benefits. Make sure you understand the possible benefits, along with which risks are greatest for you. Find out how each treatment choice may affect your long-term health.

When talking about the risks and benefits of a treatment option, ask your doctor:

• Is my calcium increase mild enough that we can use watchful waiting? If so, what would be signs that I need other treatment?
• Is there an urgent reason for me to have parathyroid surgery?
• What benefits would you expect me to get from surgery? What are the possible risks?
• Is there a medical reason why parathyroid surgery is not safe for me?
• If I don't have surgery, how is my health likely to change? Over what period of time?
• Is there a medicine that can help me? If so, what benefits might it offer? What are the possible risks?

How can you care for yourself?

If you have hyperparathyroidism, use these healthy tips.

• Try to keep track of the calcium and vitamin D you get from foods, drinks, and medicines. Check with your doctor about the amounts of calcium and vitamin D that are best for you.
• Try regular weight-bearing exercise, such as walking, to help your bone strength.
• Drink plenty of water. Not getting enough fluids can play a part in getting kidney stones.