Hyperparathyroidism

Overview

Hyperparathyroidism is a condition where one or more of your parathyroid glands make too much parathyroid hormone (often called PTH). These small glands sit in your neck, near the thyroid, and they act like a thermostat for calcium in your blood. When they release too much hormone, calcium levels in your blood can rise. High blood calcium can affect your bones, kidneys, digestion, and even how clearly you think. There are two main types. In primary hyperparathyroidism, a gland itself becomes overactive, usually because of a small harmless growth. In secondary hyperparathyroidism, the glands work harder because something else in the body is out of balance, such as kidney disease or low vitamin D.

Primary hyperparathyroidism is one of the more common hormone problems. It is often picked up by chance on a routine blood test that shows a high calcium level. Secondary hyperparathyroidism is also common, especially in people with long-term kidney disease.

Primary hyperparathyroidism is most common in adults over age 50 and is more common in women, especially after menopause. It can happen at any age, including in children, but that is rare. Secondary hyperparathyroidism is most often seen in people with chronic kidney disease or long-term low vitamin D.

Symptoms

Common symptoms

• No symptoms at all — many people feel completely well
• Feeling tired or low on energy
• Muscle weakness or aching
• Joint or bone pain
• Kidney stones
• Constipation or an upset stomach
• Feeling thirsty more often and needing to pass urine more
• Low mood, irritability, or trouble concentrating
• Feeling sick or having less appetite

Symptoms in children

• Poor growth or slower weight gain than expected
• Vague bone or leg pain
• Being very thirsty or wetting the bed more often
• Tiredness that shows up as poor school performance
• Kidney stones (uncommon in children, so this is a reason to see a doctor)
• Often found by chance during tests for another reason

Symptoms in older adults

• Often no symptoms, found on a routine calcium blood test
• Confusion, memory problems, or difficulty concentrating
• Low mood or loss of interest in usual activities
• Tiredness and general weakness
• Constipation
• Bone thinning and a higher chance of fracture
• Kidney stones or more frequent urination

Causes

Main causes

• A small, non-cancerous growth (called an adenoma) on one parathyroid gland — this causes most cases of primary hyperparathyroidism
• All four glands becoming enlarged (called hyperplasia), which can run in families
• In secondary hyperparathyroidism, the glands overwork because of long-term kidney disease, low vitamin D, or poor absorption of nutrients from the gut
• Very rarely, a cancer of the parathyroid gland
• Some inherited conditions that affect several hormone glands at once

Risk factors

• Being over 50
• Being female, especially after menopause
• A family history of hyperparathyroidism or related inherited conditions
• Past radiation treatment to the neck
• Long-term kidney disease
• Low vitamin D or poor diet
• Long-term use of certain prescription medicines — ask your doctor or pharmacist whether any of your medicines can affect calcium

When to see a doctor

See a doctor urgently if:

• Severe back or side pain, especially with fever
• Very bad constipation or vomiting that will not settle
• New confusion, drowsiness, or unusual behaviour
• Muscle weakness that is getting worse quickly
• A blood test showing a high calcium level and you feel unwell

Book a routine appointment if:

• A raised calcium level on a blood test, even if you feel fine
• Ongoing tiredness, low mood, or trouble thinking clearly
• Repeat kidney stones
• Bone or joint pain that does not settle
• Being very thirsty or passing urine more than usual
• A family history of high calcium or parathyroid problems

Diagnosis

Doctors usually start with blood tests. A high calcium level alongside a high or normal parathyroid hormone level points toward primary hyperparathyroidism. Your doctor will also check vitamin D and kidney function, because low vitamin D and kidney disease can cause a similar pattern. They will ask about your symptoms and any medicines you take, and may repeat tests to confirm the result.

Tests that may be done

• Blood tests for calcium, parathyroid hormone, vitamin D, and kidney function
• A 24-hour urine collection to see how much calcium you pass
• A bone density scan to check bone strength
• An ultrasound scan of the neck
• A special scan to locate an overactive gland before surgery
• Genetic tests, if a family pattern is suspected

What to expect at your appointment

You will usually have a few blood tests spaced over weeks, plus a conversation about your symptoms. Some tests mean coming back to the clinic, so it can take a little time to get a clear picture. If your results are mild, your doctor may simply monitor you with regular tests. If surgery might help, you may be referred to a specialist who handles hormone and neck surgery.

Treatment

Treatment depends on your calcium level, your symptoms, your age, and your bone and kidney health. People with mild primary hyperparathyroidism and no symptoms can often be safely monitored with regular blood tests and bone scans. When treatment is needed, surgery to remove the overactive gland is the most effective option and cures most cases. For secondary hyperparathyroidism, the focus is on treating the underlying cause, such as kidney disease or low vitamin D.

Self-care at home

• Drink plenty of water through the day, unless your doctor has told you to limit fluids
• Keep physically active, including gentle weight-bearing exercise like walking
• Ask your doctor before taking calcium or high-dose vitamin D supplements
• Eat a balanced diet and limit very salty foods
• Keep a symptom diary so you can share patterns with your doctor
• Go to your follow-up blood tests even when you feel well
• Tell every doctor and pharmacist about your condition, especially before starting a new medicine

Medical treatments

If surgery is not the right choice for you, or while you are waiting, doctors can offer monitoring and general supportive care. For some people there are prescription medicines that help lower blood calcium or protect bone strength — your specialist will explain whether these are suitable for you, along with the benefits and side effects. For secondary hyperparathyroidism, treatment is aimed at the cause: for example, correcting low vitamin D or managing kidney disease with your kidney team. Your doctor may also adjust other medicines that affect calcium.

When is surgery considered?

Surgery is usually considered when calcium levels are clearly high, when there are symptoms, when the kidneys or bones are being affected, or when you are younger. It is also offered to many people who would prefer a cure rather than long-term monitoring. The operation is usually small, done through a short cut in the neck, and most people go home within a day or two. Your surgical team will explain the risks and what recovery involves. If you are older with only mild changes, monitoring may be the better choice.

Living with this condition

Most people with hyperparathyroidism carry on with work, family, and hobbies as normal. The main day-to-day tasks are keeping up with blood tests, staying well hydrated, and noticing any changes in how you feel. If you have had surgery, you may need calcium and vitamin D checks afterwards — your team will tell you when. Some people find their energy and mood improve after treatment, but this can take a few weeks.

Lifestyle tips

• Stay active — walking, swimming, or light strength work all help your bones
• Avoid long periods of sitting still
• Limit alcohol and do not smoke
• Keep a regular sleep routine to help with tiredness
• Bring a list of all your medicines and supplements to every appointment
• Ask your pharmacist before buying over-the-counter remedies that contain calcium

Diet and exercise

There is no special diet that cures hyperparathyroidism, but a balanced diet helps. You do not usually need to avoid dairy — calcium from food is generally fine and your doctor can advise if you need to change anything. Cut back on very salty foods and drink enough water to keep your urine pale. Regular weight-bearing exercise, like walking, helps protect your bones. If you have kidney stones, your doctor may give you specific advice about fluids and diet.

Mental health and emotional wellbeing

High calcium and the tiredness that comes with it can affect mood, sleep, and concentration. Some people feel anxious or low, or describe 'brain fog'. These effects are real and worth mentioning to your doctor — they are part of the condition, not a personal failing. If you are feeling low or overwhelmed, tell your healthcare team. If you ever have thoughts of harming yourself, contact your local emergency number or a crisis support line straight away, or reach out to someone you trust and ask them to stay with you.

Prevention

Primary hyperparathyroidism cannot usually be prevented, because it is mostly caused by a small growth on a gland that no one can predict. Secondary hyperparathyroidism can sometimes be prevented or improved by looking after your kidneys, keeping vitamin D at a healthy level, and managing any long-term condition with your doctor. It is also worth asking your doctor to review medicines that can affect calcium if you are on them long term.

Vaccines

There is no vaccine for hyperparathyroidism. Staying up to date with routine vaccinations is still a good idea, especially if you are having surgery or have kidney disease.

Screening programmes

There is no routine screening programme for hyperparathyroidism. However, calcium is often included in standard blood tests, which is how many cases are found. If you have a family history of high calcium, kidney stones, or an inherited hormone condition, ask your doctor whether you should have your calcium checked.

Complications

If left untreated

• Bone thinning (osteoporosis) and a higher chance of broken bones
• Kidney stones and, over time, reduced kidney function
• High blood pressure
• Long-term tiredness, low mood, and memory or concentration problems
• Rarely, very high calcium levels that need urgent hospital care
• Stomach ulcers or inflammation of the stomach lining

Long-term outlook

The outlook is generally good. Surgery cures most people with primary hyperparathyroidism, and many find their energy, mood, and bone strength improve afterwards. For people with mild disease who are monitored rather than operated on, most stay stable for years with regular check-ups. Secondary hyperparathyroidism is managed by treating the underlying condition, and many people do well with good teamwork between their kidney and hormone specialists. Keep your appointments, ask questions, and let your care team know how you are feeling — that is what makes the biggest difference.

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