Hyperparathyroidism

What is hyperparathyroidism?

Hyperparathyroidism is a condition where one or more of your parathyroid glands is overactive and releases (secretes) too much parathyroid hormone (PTH). This can cause hypercalcemia, or high levels of calcium in your blood.

You have two pairs of parathyroid glands (four total) in your neck. Their job is to make sure you have enough calcium in your blood. They also reduce blood phosphate levels. They secrete PTH to send signals to:

• Your bones, telling them to release calcium and phosphate.
• Your kidneys, to reabsorb (hold onto) calcium and get rid of phosphate in your pee.

Your kidneys then send active vitamin D to your gut, which tells it to absorb calcium. Vitamin D also sends a signal back to your parathyroid glands, telling them when your body has enough calcium and they should stop releasing PTH.

When your parathyroid glands make more than enough PTH, your bones can lose too much calcium, making them thin and brittle. The calcium can also build up in your kidneys, blood vessels, heart and other parts of your body.

Types of hyperparathyroidism

Types of hyperparathyroidism include:

• Primary hyperparathyroidism. In primary hyperparathyroidism, a growth or enlargement of one or more parathyroid glands causes them to make too much PTH. They also don’t respond to your body’s signals that tell them to stop making PTH.
• Secondary hyperparathyroidism. If you have a condition that causes high phosphate levels, low vitamin D levels or low calcium levels, your parathyroid glands will make more PTH to try to increase your calcium levels and lower your phosphate levels. This is secondary hyperparathyroidism. It’s most common in people with chronic kidney disease (CKD).
• Tertiary hyperparathyroidism. Tertiary hyperparathyroidism happens if you have long-lasting secondary hyperparathyroidism that doesn’t respond to treatment. Your parathyroid glands become enlarged (hyperplasia) and continuously produce PTH.

What are the symptoms of hyperparathyroidism?

Symptoms of hyperparathyroidism, especially in people with high calcium levels, include:

• Joint or bone pain.
• Muscle weakness.
• Tiredness (fatigue).
• Depression.
• Trouble concentrating.
• Loss of appetite.
• Nausea and vomiting.
• Confusion or forgetfulness.
• Increased thirst and frequent need to pee.
• Constipation.

Sometimes you don’t have symptoms of hyperparathyroidism. Instead, you’re diagnosed during a routine blood test or tests for other conditions.

What causes hyperparathyroidism?

Growths on your parathyroid glands, parathyroid gland enlargement, and conditions that cause low levels of calcium or high levels of phosphate can all cause hyperparathyroidism. Primary, secondary and tertiary hyperparathyroidism have different causes.

Causes of primary hyperparathyroidism

When you have a growth on a parathyroid gland or one or more of the glands are enlarged, it produces more PTH and doesn’t respond to signals that tell it to stop making hormones. This causes primary hyperparathyroidism. Specific causes of primary hyperparathyroidism include:

• Adenoma. Adenomas — noncancerous (benign) growths — are the most common cause of primary hyperparathyroidism.
• Hyperplasia. Hyperplasia is an enlargement of your parathyroid glands.
• Cancer. Parathyroid carcinomas, a type of cancerous tumor, are a rare cause of primary hyperparathyroidism. Sometimes inherited conditions, like multiple endocrine neoplasia (MEN) types 1 and 2, cause these tumors.

Causes of secondary hyperparathyroidism

The most common cause of secondary hyperparathyroidism is kidney disease. When your kidneys aren’t working properly, your phosphate levels go up and your vitamin D levels go down. Low vitamin D levels lead to low calcium levels. Your parathyroid glands adjust by making more PTH to get rid of phosphate in your blood and increase the amount of calcium. Your body can usually keep up a balancing act for a while, but eventually, it won’t be able to keep up, and hypercalcemia can start damaging parts of your body.

Low vitamin D levels — from lack of sun or malnutrition — can also sometimes cause secondary hyperparathyroidism.

Causes of tertiary hyperparathyroidism

Secondary hyperparathyroidism causes tertiary hyperparathyroidism. Your parathyroid glands become enlarged from working much more than they should. This causes them to stop responding to signals that tell them not to make more PTH.

What are the risk factors for hyperparathyroidism?

Certain factors can put you at a higher risk for hyperparathyroidism. They include:

• Radiation treatment to your neck.
• Calcium or vitamin D deficiencies. The foods you eat or certain medications can cause ongoing low calcium or vitamin D levels.
• Kidney disease or damage.
• Sex. Females are more likely to have hyperparathyroidism.

What are the complications of hyperparathyroidism?

High levels of calcium in your blood can cause additional health conditions, including:

• Kidney stones from a buildup of calcium in your kidneys.
• Osteoporosis from a loss of calcium in your bones.
• Skin sores and infections from calcium buildup in your skin.
• Heart attack, high blood pressure or stroke from a buildup of calcium in your blood vessels and heart.
• Loss of kidney function after kidney transplant (graft loss).

How is hyperparathyroidism diagnosed?

Healthcare providers diagnose hyperparathyroidism by measuring your calcium, vitamin D and parathyroid hormone levels. They’ll also check your kidney function.

Primary hyperparathyroidism causes high levels of calcium in your blood and pee, and low levels of phosphate in your blood. Secondary hyperparathyroidism causes low levels of vitamin D, normal or low levels of calcium and high levels of phosphate in your blood. Providers often find hyperparathyroidism during routine tests before you have symptoms.

What tests do providers use to diagnose hyperparathyroidism?

Tests providers use to diagnose and monitor hyperparathyroidism include:

• Blood tests.
• 24-hour urine test. For this test, you collect your pee for 24 hours and then bring it to a lab for testing. Your provider will give you instructions on how to complete a 24-hour urine test.
• Parathyroid scan. Also called a sestamibi scan, providers can use a parathyroid scan to help locate which gland or glands are producing too much PTH. Before surgery, they may use the scan to locate specific areas to remove.
• Ultrasounds or other imaging of your kidneys or parathyroid glands.
• Bone density scans.

How is hyperparathyroidism treated?

The type of treatment depends on whether you have primary or secondary hyperparathyroidism. Treatments could include surgery, supplements and/or lifestyle changes.

Treatment for primary hyperparathyroidism

Surgery to remove a growth or an enlarged parathyroid gland (parathyroidectomy) can cure hyperparathyroidism. Your provider might be more likely to recommend surgery if you’re younger than 50 or you have:

• Symptoms of hypercalcemia.
• High levels of calcium or creatinine in your blood or pee.
• Kidney stones.
• Calcium deposits in your kidneys.
• Osteoporosis.

If you don’t have surgery, your provider will monitor your symptoms, calcium levels and kidney function. They may also recommend or prescribe:

• Bisphosphonates. Bisphosphonates prevent calcium loss from your bones and improve your bone density. Examples of bisphosphonates include etidronate (Didronel®), alendronate (Fosamax®), zoledronic acid (Zometa®) and ibandronate (Boniva®).
• Calcimimetics. Calcimimetics act like calcium in your tissues and tell your parathyroid glands to produce less PTH. Providers more often use them to treat secondary hyperparathyroidism. Cinacalcet (Sensipar®) and etelcalcetide (Parsabiv®) are examples of calcimimetics.
• Avoiding certain medications. Some medications, like thiazide diuretics and lithium, can increase your calcium levels.
• Dietary changes. Your provider might recommend getting a certain amount of calcium or vitamin D through supplements or the foods you eat.

Treatment for secondary hyperparathyroidism

Treating secondary hyperparathyroidism can be complex. You and your provider will work together to treat the root cause. If you have chronic kidney disease, you might need dialysis or a kidney transplant. Your provider may recommend talking to a dietitian about a kidney-friendly meal plan, like avoiding phosphorus, and/or prescribe medications. Medications may include:

• Phosphate binders. These medications reduce the amount of phosphate in your blood.
• Ergocalciferol (vitamin D2). This treats low vitamin D levels.
• Calcimimetics. Your provider may prescribe cinacalcet (Sensipar) or etelcalcetide (Parsabiv) to reduce your levels of PTH.

If these strategies don’t work or if you develop tertiary hyperparathyroidism, your provider will probably recommend surgery.

Can you prevent hyperparathyroidism?

Managing underlying conditions, like chronic kidney disease, can reduce your risk of secondary hyperparathyroidism. There aren’t specific ways to reduce your risk of primary hyperparathyroidism.

What can I expect if I have hyperparathyroidism?

If you have hyperparathyroidism and don’t have surgery, you’ll need to monitor your symptoms. You might also need to make changes to what you eat or take medications or supplements. Once or twice per year, your provider will test your:

• Blood calcium levels.
• Blood pressure.
• Kidney function.
• Bone density.

How effective is surgery for hyperparathyroidism?

For people with primary hyperparathyroidism, parathyroidectomy is very effective at bringing calcium levels back to normal, and at improving bone density and symptoms. Studies suggest that, after surgery, over 80% of people (4 out of 5) saw symptom improvement, and over 90% (9 out of 10) had calcium levels return to normal and bone density improve.

Kidney transplant improves secondary hyperparathyroidism in about 40% of people within a year.

How long can you live with hyperparathyroidism?

Many people live with primary hyperparathyroidism for years without it affecting their health. But eventually, you may need surgery to treat it. Studies suggest that, of people who don’t have symptoms of primary hyperparathyroidism at the time of their diagnosis, about 25% (1 out of 4) will eventually need surgery.

How do I take care of myself?

If you have hyperparathyroidism, the following tips can help you take care of yourself:

• Drink plenty of water to stay hydrated.
• Stay active and exercise to keep your bones strong.
• If your provider recommends limiting foods with phosphorous in them, avoid foods with ingredients that include “-phos” (like calcium phosphate or phosphoric acid).

Should you take vitamin D if you have hyperparathyroidism?

For some people with hyperparathyroidism and low vitamin D levels, it might make sense to take vitamin D supplements. Always ask your provider what kinds of foods, beverages and supplements you should be looking for — and what you should avoid.

When should I see my healthcare provider?

See a healthcare provider if you have symptoms of hyperparathyroidism. If you have another health condition that puts you at risk for hyperparathyroidism, talk to your provider about symptoms to look out for and when you should check in with them.

What questions should I ask my doctor?

It might be helpful to ask your healthcare provider:

• Are there other tests I need to have?
• What are my treatment options?
• What changes do I need to make in what I eat or drink?
• Are there foods or medications/supplements I should avoid?
• What symptoms should I look out for?
• How do I monitor my condition?
• When do I need to follow up?

Is hyperparathyroidism a serious condition?

Some people can manage hyperparathyroidism without it ever affecting their health. For others, especially people with kidney disease, hyperparathyroidism can cause serious complications.