Primary hyperparathyroidism

Overview

Primary hyperparathyroidism is a condition where one or more of the four small parathyroid glands in your neck make too much parathyroid hormone (PTH). This causes calcium levels in your blood to rise, which can lead to weak bones, kidney stones, and other problems. Many people have no symptoms and only find out during a routine blood test.

Yes, it is fairly common, especially in people over 50. It is the leading cause of high calcium levels in people who are not hospitalized.

It affects women more than men, especially after menopause. People over 50 are at higher risk. It can also run in families or be linked to certain genetic conditions.

Symptoms

Common symptoms

• No symptoms at all (many people find out by accident)
• Feeling tired or weak
• Bone or joint pain
• Frequent urination or thirst
• Kidney stones
• Depression or trouble concentrating

Symptoms in children

• Rare, but may cause failure to thrive, weak bones, or kidney stones

Symptoms in older adults

• Increased confusion or memory problems
• Fatigue and muscle weakness
• Loss of appetite or nausea
• Bone pain and higher risk of falls

Causes

Main causes

• A benign (non-cancerous) tumor called an adenoma on one of the parathyroid glands (most common)
• Enlargement of all four parathyroid glands (hyperplasia)
• Very rarely, a cancerous tumor of the parathyroid

Risk factors

• Radiation exposure to the neck area (e.g. from past cancer treatment)
• Family history of primary hyperparathyroidism
• Certain genetic conditions (e.g. multiple endocrine neoplasia type 1)

When to see a doctor

See a doctor urgently if:

• If you develop severe confusion, extreme thirst, or pass out
• If you have sudden severe back or side pain (possible kidney stone blocking urine)
• If you break a bone easily

Book a routine appointment if:

• If a routine blood test shows high calcium levels
• If you have ongoing symptoms like tiredness, bone pain, or depression
• If you have a family history of the condition

Diagnosis

It is usually discovered through a blood test that shows high calcium and high parathyroid hormone (PTH) levels. Your doctor will confirm the diagnosis with follow-up tests.

Tests that may be done

• Blood test to measure calcium and PTH levels
• 24-hour urine test to check how much calcium your kidneys are excreting
• Bone density scan (DXA) to check for bone loss
• Imaging tests like ultrasound or a nuclear scan to locate overactive glands
• X-rays or CT scans if kidney stones are suspected

What to expect at your appointment

Diagnosis is straightforward with blood tests. Your doctor may then refer you to a specialist (endocrinologist) for further assessment. The process is usually done as an outpatient and is not painful.

Treatment

Treatment depends on whether you have symptoms, how high your calcium is, and your overall health. Options include monitoring, medications, or surgery. Your doctor will help you decide the best approach.

Self-care at home

• Drink plenty of water to stay hydrated and help prevent kidney stones
• Avoid becoming dehydrated (especially in hot weather or when sick)
• Limit caffeine and alcohol, which can worsen dehydration
• Get regular moderate exercise to help keep bones strong

Medical treatments

If surgery is not recommended or you are not a candidate, your doctor may prescribe medicines to lower calcium levels or protect your bones. These are not a cure but can help manage the condition. Always follow your doctor's advice about these treatments.

When is surgery considered?

Surgery to remove the overactive gland (parathyroidectomy) is the only cure. It is usually recommended if you have symptoms, high calcium levels, low bone density, or kidney stones. It is a safe operation with a high success rate.

Living with this condition

Many people with primary hyperparathyroidism live normally without symptoms. If you are being monitored, you will have regular blood tests and check-ups. If you have symptoms, treatment can help you feel better.

Lifestyle tips

• Stay well hydrated every day
• Avoid high-dose calcium supplements (unless your doctor advises them)
• Get enough vitamin D (ask your doctor about safe levels)
• Maintain a healthy weight to reduce stress on bones and joints

Diet and exercise

Eat a balanced diet with moderate calcium (from food, not supplements). Include vitamin D-rich foods like oily fish and eggs. Do weight-bearing exercise (walking, dancing, stair climbing) to keep bones strong. Talk to your doctor before starting any new exercise or diet plan.

Mental health and emotional wellbeing

Living with a chronic condition can cause anxiety or stress. You may worry about bone health or the need for surgery. It is normal to feel this way. Talk to your doctor or a counselor if you need support.

Prevention

In most cases, primary hyperparathyroidism cannot be prevented because it is caused by a benign growth or gland enlargement. Avoiding radiation to the neck may lower your risk, but this is rare.

Vaccines

There is no vaccine for primary hyperparathyroidism.

Screening programmes

There is no routine screening for the general population. It is usually found when blood tests are done for other reasons.

Complications

If left untreated

• Kidney stones and kidney damage
• Loss of bone density (osteoporosis) and higher risk of fractures
• High blood pressure and heart problems
• Digestive issues like nausea, vomiting, or constipation
• Muscle weakness and fatigue

Long-term outlook

The outlook is very good. With proper monitoring or treatment, most people with primary hyperparathyroidism can manage their symptoms and prevent complications. Surgery often cures the condition, and even without surgery, many people live well for years with regular check-ups.

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