14454 Hyperparathyroidism

Overview

Hyperparathyroidism happens when one or more of your parathyroid glands produce too much parathyroid hormone, or PTH. These are four tiny glands in your neck. PTH normally helps keep the right balance of calcium in your blood and bones. When too much is made, calcium levels can go too high and cause problems over time.

It is fairly common, especially in people over 50. Primary hyperparathyroidism is the most common type seen in general practice.

Women are about two to three times more likely to develop primary hyperparathyroidism than men. It is most often diagnosed after age 50.

Symptoms

Common symptoms

• No symptoms at all – many people feel fine when it is first found
• Persistent tiredness or feeling weak
• Bone and joint aches
• Kidney stones – pain in your side or back, blood in urine
• Frequent urination and thirst
• Feeling low, anxious, or 'brain fog'

Symptoms in children

• Hyperparathyroidism is rare in children. When it does happen, symptoms can be more severe. They may include poor feeding, vomiting, constipation, and muscle weakness. If your child seems unwell or has unusual symptoms, speak to your doctor.

Symptoms in older adults

• Many older adults have no obvious symptoms, but some may develop confusion, memory problems, or depression. Osteoporosis (thinning of bones) may also be found during a bone scan.
• Severe symptoms such as extreme drowsiness or confusion need urgent medical help.

Causes

Main causes

• Primary hyperparathyroidism: usually one parathyroid gland becomes overactive because of a non-cancerous growth called an adenoma. In rare cases, all four glands are overactive.
• Secondary hyperparathyroidism: the parathyroid glands work too hard to make up for very low calcium levels. This is often linked to vitamin D deficiency or kidney disease.
• Tertiary hyperparathyroidism: this happens mostly in people who have had kidney disease for a long time, or after a kidney transplant.

Risk factors

• Being female
• Being over 50
• A history of radiation therapy to the neck
• Long-term vitamin D deficiency
• Chronic kidney disease
• Rare genetic conditions such as multiple endocrine neoplasia (MEN)

When to see a doctor

See a doctor urgently if:

• If you have symptoms of very high calcium in the blood, such as confusion, drowsiness, severe vomiting, or a sudden change in how much you drink or urinate, call your local emergency number immediately.
• If you are having severe pain in your side or back that may be a kidney stone, get urgent medical care the same day.

Book a routine appointment if:

• If you have been told your blood calcium is high, or you have ongoing tiredness, bone pain, or depression-like symptoms, make a routine appointment with your doctor.

Diagnosis

Hyperparathyroidism is usually diagnosed with blood tests. Your doctor will check your calcium level and your parathyroid hormone (PTH) level at the same time. They may also check your vitamin D and kidney function.

Tests that may be done

• Blood tests for calcium, PTH, and vitamin D
• A 24-hour urine test to see how much calcium your body is losing
• Bone density scan to check bone strength
• An ultrasound or other scan of your neck to look for an overactive gland (sometimes used)
• Kidney ultrasound if stones are suspected

What to expect at your appointment

Your doctor will talk you through each step. You may be referred to an endocrinologist, a specialist in hormones. If surgery is being considered, you might be seen by a surgeon who specialises in the neck. Tests are done to make sure both diagnosis and treatment are right for you.

Treatment

Treatment depends on the type of hyperparathyroidism, your calcium level, and whether you have symptoms or complications. For mild primary hyperparathyroidism, some people only need careful monitoring. For others, a medicine or surgery can help.

Self-care at home

• Stay well hydrated. Drinking enough water helps your kidneys remove extra calcium.
• Keep physically active. Regular movement helps keep bones strong.
• Do not take calcium supplements without speaking to your doctor first. Some people need them, but others do not.
• Avoid very large amounts of vitamin D supplements unless prescribed by your doctor.
• If you smoke, consider stopping – smoking reduces bone strength.

Medical treatments

There are no medicines that cure primary hyperparathyroidism directly, but some treatments can help lower calcium levels or protect your bones. Your doctor may prescribe a type of medicine that lowers the amount of parathyroid hormone, or you may be offered treatments for bone thinning. Always talk to your doctor about the benefits and risks of any medicine.

When is surgery considered?

Surgery to remove the overactive parathyroid gland is the only way to treat primary hyperparathyroidism. It is often recommended if your calcium level is quite high, if you have kidney stones, if your bones are thinning, or if you are under 50 and have other risk factors. Many people are cured after surgery.

Living with this condition

If your hyperparathyroidism is mild, you may not need any daily treatment. You will have regular blood tests and check-ups. If you have had surgery, your calcium level usually returns to normal within days. Keep up with your appointments so any changes are caught early.

Lifestyle tips

• Take gentle exercise, such as walking or swimming, most days. Try to include some weight-bearing activity – even light weights or fitness classes – if your doctor agrees.
• Get a little sunlight on your skin for vitamin D, but avoid burning. You can also eat foods such as oily fish and eggs.
• Maintain a healthy weight. Being severely overweight or underweight can affect bone and hormone health.
• Limit how much alcohol you drink. Too much alcohol can weaken bones.

Diet and exercise

For most people with hyperparathyroidism, it is safer not to have very low or very high amounts of calcium in your diet. Aim for a normal, balanced diet with dairy products, green leafy vegetables and nuts, unless your doctor gives different advice. Do not take calcium supplements unless recommended. A dietitian can help if you are unsure.

Mental health and emotional wellbeing

It can be stressful to learn you have a condition that affects your hormones. Hyperparathyroidism is sometimes linked with feeling low, anxious, or having trouble focusing. Talk to your doctor if you notice these feelings – treatment may improve your mood, and support is available.

Prevention

Most cases of primary hyperparathyroidism cannot be prevented, because they are caused by a growth or overactivity in a gland. However, you can reduce your risk of secondary hyperparathyroidism by getting enough vitamin D and looking after your kidneys if you have kidney disease.

Vaccines

There is no vaccine for hyperparathyroidism.

Screening programmes

There is no routine national screening programme for hyperparathyroidism in most countries. However, if you have a family history of a related genetic condition, your doctor may suggest regular monitoring.

Complications

If left untreated

• Kidney stones, which can cause pain and sometimes block the flow of urine
• Bone thinning (osteoporosis) and fractures
• Impaired kidney function over time
• Stomach ulcers and acid reflux in some cases
• High calcium crises requiring emergency care, though rare

Long-term outlook

The outlook is positive. Most people with primary hyperparathyroidism are treated successfully, and many feel better once calcium levels are back to normal. Even people who choose not to have treatment can be monitored regularly and can live well for many years. Your doctor will help you make a plan that keeps you healthy and comfortable.

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