Learn about symptoms, tests and treatment for this condition caused by overactivity of the parathyroid gland.
Hyperparathyroidism is when your parathyroid glands create high amounts of parathyroid hormone in the bloodstream. These glands, located behind the thyroid at the bottom of your neck, are about the size of a grain of rice.
The parathyroid hormone produced by the thyroid glands helps maintain the right balance of calcium in the bloodstream and in tissues that depend on calcium for proper functioning. This is especially important for nerve and muscle function, as well as bone health.
There are two types of hyperparathyroidism. In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of parathyroid hormone. This causes high calcium levels in the blood, which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.
Secondary hyperparathyroidism occurs due to another disease that first causes low calcium levels in the body. Over time, increased parathyroid hormone levels occur as the body fights to keep the calcium level up in the standard range. This is common in kidney disease and after certain intestinal surgeries or diseases.
The parathyroid glands lie behind the thyroid. They produce parathyroid hormone, which plays a role in regulating the body's blood level of calcium and phosphorus.
Primary hyperparathyroidism is often diagnosed before signs or symptoms of the disorder occur. This is usually because an elevated level of calcium is found on routine blood tests. When symptoms do occur, they're the result of damage or dysfunction in other organs or tissues. This damage or dysfunction is due to high calcium levels in the blood and urine or too little calcium in bones.
Symptoms may be so mild and nonspecific that they don't seem related to parathyroid function, or they may be severe. The range of signs and symptoms include:
See your health care provider if you have any signs or symptoms of hyperparathyroidism. These symptoms could be caused by many disorders, including some with serious complications. It's important to get a prompt, accurate diagnosis and the right treatment.
Hyperparathyroidism is caused by factors that increase the production of parathyroid hormone.
The parathyroid glands keep proper levels of both calcium and phosphorus in your body by turning the release of parathyroid hormone off or on. This is similar to how a thermostat controls a heating system to maintain a constant air temperature. Vitamin D also is involved in controlling the amount of calcium in your blood.
Normally, this balancing act works well.
Calcium is best known for its role in keeping your teeth and bones healthy. But calcium also aids in the transmission of signals in nerve cells. And it's involved in muscle contraction. Phosphorus, another mineral, works along with calcium in these areas.
Sometimes one or more of the parathyroid glands produce high amounts of parathyroid hormone. These high hormone levels can be the body responding appropriately to keep the calcium in the standard range, or they may be inappropriately elevating the calcium in the blood. Which one depends on the underlying problem.
Hyperparathyroidism may occur because of primary hyperparathyroidism or secondary hyperparathyroidism.
Primary hyperparathyroidism occurs because of a problem with one or more of the four parathyroid glands:
One or more of the parathyroid glands produces high amounts of parathyroid hormone. This leads to high calcium levels and low phosphorus levels in your blood. Primary hyperparathyroidism usually occurs randomly. But some people inherit a gene that causes the disorder.
Secondary hyperparathyroidism is the result of another condition that lowers the blood calcium, which then affects the gland's function. This causes your parathyroid glands to overwork and produce high amounts of parathyroid hormone to maintain or restore the calcium level to the standard range. Factors that may result in secondary hyperparathyroidism include:
Severe vitamin D deficiency. Vitamin D helps maintain appropriate calcium levels in the blood. It also helps your digestive system absorb calcium from your food.
Your body produces vitamin D when your skin is exposed to sunlight. You also get some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.
Chronic kidney failure. Your kidneys convert vitamin D into a form that your body can use. If your kidneys work poorly, usable vitamin D may decrease and calcium levels drop. This causes parathyroid hormone levels to go up. Chronic kidney failure is the most common cause of secondary hyperparathyroidism.
In some people with long-term secondary hyperparathyroidism, usually from end-stage kidney disease, the parathyroid glands enlarge. They begin to release parathyroid hormone on their own. The hormone level doesn't go down with medical treatment and the blood calcium becomes too high. This is called tertiary hyperparathyroidism, and people with this condition may require surgery to remove parathyroid tissue.
You may be at an increased risk of primary hyperparathyroidism if you:
Complications of hyperparathyroidism are mainly related to the long-term effect of too little calcium in your bones and too much calcium in your bloodstream. Common complications include:
In most cases, elevated calcium is found by blood tests ordered for other reasons. For example, routine blood work or testing to figure out the cause of symptoms of another condition. Your provider may diagnose hyperparathyroidism by ordering:
If blood test results show that you have high calcium levels in your blood, your health care provider will likely repeat the test. This repeated test can confirm the results after you haven't eaten for a period of time.
Many conditions can raise calcium levels. But your health care provider can diagnose hyperparathyroidism if blood tests show you also have high levels of parathyroid hormone.
After diagnosing primary hyperparathyroidism, your health care provider will likely order more tests. These can rule out possible conditions causing hyperparathyroidism, identify possible complications and determine the severity of the condition. These tests include:
Bone mineral density test. This test is done to see if you have developed osteoporosis. The most common test to measure bone mineral density is dual-energy X-ray absorptiometry (DEXA).
This test uses special X-ray devices to measure how many grams of calcium and other bone minerals are packed into a bone segment.
Urine test. A 24-hour collection of urine can provide information on how well your kidneys work and how much calcium is passed in your urine.
This test may help your provider determine the severity of hyperparathyroidism or diagnose a kidney disorder causing hyperparathyroidism. If a very low calcium level is found in the urine, this may mean it's a condition that doesn't need treatment.
If your health care provider recommends surgery, one of these imaging tests may be used to locate the parathyroid gland or glands that are causing problems:
Sestamibi parathyroid scan. Sestamibi is a radioactive compound that is absorbed by overactive parathyroid glands. It can be detected by a scanner that detects radioactivity.
A healthy thyroid gland also absorbs sestamibi. To keep the thyroid absorption from blocking the view of the absorption in a parathyroid tumor (adenoma), you're also given radioactive iodine. This is only absorbed by the thyroid. Using this process, the thyroid image is digitally removed so it can't be seen.
Computerized tomography (CT) scanning may be combined with the sestamibi scan to improve detection of any problems with the parathyroid glands.
Ultrasound. Ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue.
A small device held against your skin (transducer) sends out high-pitched sound waves and records the sound wave echoes as they reflect off internal structures. A computer converts the echoes into images on a monitor.
Treatment options for primary hyperparathyroidism can include watchful waiting, surgery and medications.
Your health care provider may recommend no treatment and regular monitoring if:
If you choose this watch-and-wait approach, you'll likely need regularly scheduled tests to monitor your blood-calcium levels and bone density.
Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in most cases. A surgeon will remove only those glands that are enlarged or have a tumor.
If all four glands are affected, a surgeon will likely remove only three glands and perhaps a portion of the fourth — leaving some functioning parathyroid tissue.
Surgery may be done as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery can be done through very small cuts (incisions) in the neck. You receive only local anesthetics to numb the area.
Complications from surgery aren't common. Risks include:
Medications to treat hyperparathyroidism include the following:
Calcimimetics. A calcimimetic is a drug that mimics calcium circulating in the blood. The drug may trick the parathyroid glands into releasing less parathyroid hormone. This drug is sold as cinacalcet (Sensipar).
Cinacalcet may be an option to treat primary hyperparathyroidism, particularly if surgery hasn't successfully cured the disorder or a person isn't a good surgery candidate.
Cinacalcet and vitamin D analogs (prescription forms of vitamin D) are used to manage secondary hyperparathyroidism in chronic kidney disease. These medications help keep the balance of calcium and phosphorus minerals so that the parathyroid glands don't have to work hard.
The most commonly reported side effects of cinacalcet are joint and muscle pain, diarrhea, nausea, and respiratory infection.
Hormone replacement therapy. For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones keep calcium. However, this treatment doesn't address the underlying problems with the parathyroid glands.
Prolonged use of hormone replacement therapy can increase the risk of blood clots and breast cancer. Work with your health care provider to evaluate the risks and benefits to help you decide what's best for you.
Some common side effects of hormone replacement therapy include breast pain and tenderness, dizziness, and headaches.
If you and your health care provider have chosen to monitor, rather than treat, your primary hyperparathyroidism, the following suggestions can help prevent complications:
Monitor how much calcium and vitamin D you get in your diet. Restricting how much calcium you eat or drink is not recommended for people with hyperparathyroidism.
The daily recommended amount of calcium for adults ages 19 to 50 and men ages 51 to 70 is 1,000 milligrams (mg) of calcium a day. That calcium recommendation increases to 1,200 mg a day for women age 51 and older and men age 71 and older.
The daily recommended amount of vitamin D is 600 international units (IUs) of vitamin D a day for people ages 1 to 70 and 800 IUs a day for adults age 71 and older. Talk to your provider about dietary guidelines that are right for you.
In most cases, elevated calcium is detected by blood tests your health care provider has ordered as part of a routine screening, tests for an unrelated condition or tests to identify the cause of very general symptoms.
Talk to your provider about your test results if they show you have high levels of calcium. Questions you might ask include:
To understand the effect of hyperparathyroidism on your overall health, your provider may ask you questions about possible mild signs or symptoms, including:
Your health care provider may ask you additional questions about what medications you're taking and what your diet is like to help determine if you get adequate amounts of calcium and vitamin D.