Hyperparathyroidism – Diagnosis and Treatment
Hyperparathyroidism is a medical condition that affects the parathyroid glands, small glands in the neck that help control calcium levels in the body.
When these glands produce too much parathyroid hormone, high calcium levels can result, causing health problems such as weak bones, kidney stones, or fatigue.
This condition can develop on its own or as a result of other diseases. People with hyperparathyroidism may not notice symptoms right away, so understanding how the disorder works and how doctors diagnose and treat it is important.
Diagnosis
Checking Calcium and Parathyroid Hormone Levels
Doctors often discover hyperparathyroidism through routine blood testing, even when looking for other health concerns.
If blood tests reveal that calcium levels are above normal, the doctor will usually ask for another blood sample after fasting to confirm these findings.
Doctors consider a diagnosis more likely when blood work also shows that parathyroid hormone (PTH) levels are high. High PTH with high blood calcium points to overactive parathyroid glands.
Doctors also consider other causes of high calcium, but this combination is a strong clue.
Key measurements in blood tests:
| Lab Test | Why It’s Important |
|---|---|
| Serum calcium | Confirms high calcium level |
| Parathyroid hormone (PTH) | Shows if PTH is elevated |
| Vitamin D | Checks if vitamin D is low or high |
| Phosphorus | Examines effects on mineral levels |
Other Checks Used for a Full Picture
After confirming primary hyperparathyroidism, doctors use more tests to check for possible effects on bones and kidneys or to rule out other possible problems. These extra steps include:
- Bone Density Exam: A special X-ray test (DEXA scan) measures bone strength to see if bone loss or osteoporosis is present.
- Urine Collection Test: A full-day (24-hour) urine sample shows how much calcium leaves the body through urine and how the kidneys are working. This can help identify the risk of kidney disease or stones.
- Kidney Imaging: Pictures of the kidneys, sometimes using X-ray or ultrasound, help doctors look for kidney stones or damage caused by extra calcium in the blood.
These tests help doctors determine how severe the parathyroid disease is and if other health risks exist.
Finding the Problem Gland Before Surgery
For people who may need an operation to remove abnormal parathyroid tissue, tests can help show which gland is causing trouble. Common scans used are:
- Sestamibi Scan: This imaging test uses a small amount of a radioactive chemical that collects in overactive parathyroid glands. By scanning the neck and chest, doctors can locate the problem area. Sometimes, a CT scan is used with it for more detail.
- Neck Ultrasound: Ultrasound uses sound waves to produce clear images of the parathyroid and thyroid glands. This test does not use radiation and can often show the enlarged gland.
These imaging tests help the surgical team plan the operation with precision.
Extra Details
- Doctors check secondary hyperparathyroidism using similar blood and urine tests, but it is often related to other health conditions, like kidney disease.
- In some cases, doctors may order more advanced scans or tests if the common imaging tests do not show the abnormal gland.
- Doctors may recommend regular checkups and repeat blood work after diagnosis to monitor calcium and PTH levels over time.
- The combination of blood, urine, and imaging tests gives a complete overview for proper management of parathyroid disease.
Treatment
Careful Observation
Doctors may suggest monitoring instead of treating right away if the patient’s calcium levels are only mildly raised.
This option is often chosen when kidney function is normal, there are no kidney stones, and bone density is close to the average range.
People who do not have symptoms that require urgent attention may also be offered this method.
During this period, patients attend regular appointments. These usually include blood tests for calcium and checks on bone strength using scans.
The goal is to spot any changes early and decide if treatment should begin later. This approach avoids unnecessary treatment for those whose condition is not causing harm.
Checklist for Careful Observation:
- Annual blood calcium tests.
- Bone density scans every 1-2 years.
- Monitoring kidney health.
Surgical Removal of Parathyroid Tissue
Doctors use surgery as the leading method to resolve primary hyperparathyroidism. Most people are cured when surgeons remove the problem parathyroid gland or glands.
This procedure, called a parathyroidectomy, can often be done on an outpatient basis with small neck incisions, so patients usually go home the same day.
If all four glands are affected, surgeons usually take out at least three, or nearly all, and keep a small portion to maintain some hormone function.
The risks from surgery are uncommon but may include problems with vocal cord nerves or having too little calcium afterward. Some people will need to take calcium and vitamin D supplements if their calcium levels drop too much.
Common Surgery Options:
| Procedure | Description | Notes |
|---|---|---|
| Removal of one gland | Only the enlarged/tumor-affected gland is taken out. | Most common surgery |
| Subtotal parathyroidectomy | 3 to 3.5 glands removed when all are abnormal. | Leaves some functioning tissue |
| Minimally invasive approach | Smaller incisions, can be done with local anesthetic. | Outpatient, quicker recovery |
Possible Side Effects:
- Hoarse voice
- Numbness or tingling from low calcium
- Need for lifelong supplements if all glands are removed
Prescription Therapies
When surgery is not suitable or does not resolve the issue, medications can help regulate calcium and protect bones.
Medicines Used:
- Calcimimetics: These drugs trick the parathyroid glands into making less hormone, lowering calcium in the blood. They may help patients who cannot have surgery.
- Bisphosphonates: These drugs help keep calcium in the bones and reduce bone loss. They do not fix high calcium in the blood.
- Hormone Replacement Therapy: Doctors may give this mainly to postmenopausal women with low bone density. It can prevent further bone thinning but will not address the hormone problem itself.
Potential Side Effects Table:
| Medication | Possible Side Effects |
|---|---|
| Calcimimetics | Nausea, muscle aches, joint pain, diarrhea |
| Bisphosphonates | Low blood pressure, fever, vomiting |
| Hormone Therapy | Headache, dizziness, breast tenderness |
Doctors may prescribe supplements like calcium and vitamin D if levels drop too low after treatment.
Ways to Care for Yourself
Managing hyperparathyroidism often involves watching key aspects of daily life. One important step is to pay close attention to calcium and vitamin D intake.
For most adults, the suggested calcium intake is 1,000 mg daily. Women over 51 years old and men over 71 years old should get 1,200 mg a day. Vitamin D is also important. Most adults need 600 IUs each day.
For adults over 71, that goes up to 800 IU. Tracking your daily intake can be helpful. Use a table like the one below to see if you meet your body’s needs:
| Age Group | Calcium (mg/day) | Vitamin D (IU/day) |
|---|---|---|
| Adults 19-50 | 1,000 | 600 |
| Women 51+ / Men 71+ | 1,200 | 800 |
Doctors do not recommend limiting calcium if you have hyperparathyroidism, but always talk to a healthcare provider for advice that fits your needs.
Staying hydrated is also key. Drink water until your urine is almost clear. Good hydration can help reduce the risk of kidney stones.
Physical activity, like walking or strength training, helps keep bones strong. A provider can recommend safe exercises based on each person’s situation.
Smoking should be avoided, as it may increase bone loss and other health issues. Support is available for those who want to quit.
Certain medicines, such as some types of diuretics or lithium, can make calcium levels go up. Ask your provider if your current medications are safe.
Getting Ready for Your Medical Visit
Before meeting with a healthcare provider, it can help to prepare so all important concerns are addressed.
If blood tests show high calcium levels, the provider may have ordered these as part of routine screening or to check for other problems. Elevated calcium could mean hyperparathyroidism or another issue, so being ready with questions is helpful.
A list of questions to ask might include:
- Do I have hyperparathyroidism?
- What further tests are needed?
- Should I be referred to a hormone specialist (endocrinologist)?
- What treatment choices do I have, including surgery or nonsurgical options?
- How might my other medical issues affect treatment plans?
- Are there helpful materials available for me to review at home?
A healthcare provider often asks about symptoms that are not always obvious. These may include:
- Feeling sad or depressed
- Constant tiredness or low energy
- Unexplained muscle aches or joint pain
- Trouble remembering things or staying focused
- More thirst than usual, or frequent urination
Patients should keep track of any symptoms, even those that seem small, and share them during the visit. This gives the provider a better understanding of the whole picture.
Providers may also want information about current medications and diet. This helps them see if enough calcium and vitamin D are being consumed and if any supplements or drugs could be affecting test results.
Preparing a list of all medicines, including over-the-counter items and vitamins, is useful.
| Information to bring to your appointment | Examples |
|---|---|
| List of symptoms | Fatigue, pain, memory issues |
| All medications and supplements | Prescription drugs, vitamins, calcium |
| Past medical history | Kidney problems, bone health concerns |
| Recent lab results | Calcium levels, hormone tests |
| Questions for your provider | See sample question list above |
Ways to get more out of your appointment:
- Write down questions and symptoms ahead of time.
- Bring a family member or friend for support.
- Organize important medical papers or recent blood test results.
- Be ready to discuss eating and activity habits.
If the healthcare provider suspects hyperparathyroidism, they may suggest more tests. This might include checking parathyroid hormone levels or other blood work.
The provider may also ask about family history and evaluate how any other health issues could interact with the main problem.
Preparing well for a healthcare visit allows for clearer communication. It helps ensure that all concerns—big or small—are addressed, and that both the patient and provider can make informed decisions.
Being open and thorough in sharing information can lead to better care and more effective treatment.
More Information
Primary hyperparathyroidism can cause health issues involving different organs and body systems. Some people have no symptoms and only discover the condition through routine blood tests.
Others may notice fatigue, weakness, depression, or confusion. These symptoms can affect daily activities.
Common signs and complications include:
- Bone Problems: Osteoporosis and joint pain may develop, increasing the risk for fractures.
- Kidney Issues: Kidney stones (nephrolithiasis) can form, and people may experience excess urination or increased thirst.
- Digestive Symptoms: People might have nausea, vomiting, constipation, GERD, or even peptic ulcer disease.
- Other Symptoms: Loss of appetite and weight loss sometimes appear. Some may have muscle weakness.
| Symptom/Condition | Some Associated Issues |
|---|---|
| Osteoporosis | Weakened bones, higher fracture risk |
| Kidney stones | Pain, risk of chronic kidney disease |
| Depression | Mood changes, memory loss |
| Fatigue/Weakness | Limits on daily tasks |
| Increased thirst | Frequent urination |
| Confusion | Affects memory and thinking |
Risk factors for developing hyperparathyroidism include being female, older age, having a family history, or inherited conditions like multiple endocrine neoplasia type 1 or familial hypocalciuric hypercalcemia.
Rare complications such as pancreatitis or high blood pressure may occur. Chronic high calcium levels can damage the heart and blood vessels, raising the chance of cardiovascular disease.
In some infants, neonatal hypoparathyroidism causes symptoms related to low calcium levels, or hypocalcemia.
Doctors recommend regular follow-up for both symptom-free and symptomatic patients to monitor for changes or problems related to the parathyroid glands.
