What is hyperparathyroidism?

Hyperparathyroidism develops from too much activity in one or more parathyroid glands, the grain-of-rice-sized structures near the thyroid glands in your neck.The parathyroid glands create parathyroid hormone (PTH), which boosts the levels of calcium in the bloodstream when needed. Too much PTH is produced from:

• Primary Hyperparathyroidism, which is usually tied to an enlargement (hyperplasia) of a parathyroid gland, a benign (non-cancerous) growth (adenoma) or (in rare cases) a malignant (cancerous) tumor. The reasons for enlargement are usually undetermined but can be hereditary.

• Secondary Hyperparathyroidism, when certain medical conditions skew the levels of calcium and a related mineral, phosphate. That prompts the parathyroid glands to compensate and is caused by such problems as a vitamin D or calcium deficiency, or by kidney failure.

The extra PTH causes the release of calcium from the bones, which can lead to high levels of the mineral in the blood (hypercalcemia) and problems like:

• Osteoporosis: a weakening of the bones that can make them more susceptible to fractures

• Osteopenia: a condition that often precedes osteoporosis

• Kidney Stones: hard deposits that result from excess calcium getting in the urine and getting filtered by the kidneys

• Cardiovascular Disease: research suggests that high-calcium levels are associated with high blood pressure (hypertension) and some types of heart disease

What are the risk factors for hyperparathyroidism?

Hyperparathyroidism mainly occurs in patients over 60 but can also develop in younger adults. Risk factors include:

• Gender: Women are more likely to get the condition than men.

• Radiation Therapy: Treatment for other neck cancers can affect the parathyroid glands.

• Nutritional Deficiencies: Severe, ongoing vitamin D or calcium deficiencies can trigger hyperparathyroidism.

• Lithium Use: Lithium, a drug used to treat bipolar disorder, can affect calcium levels.

What are the symptoms of hyperparathyroidism?

Mild hyperparathyroidism might not cause any symptoms, and is sometimes diagnosed in blood tests before any problems are noticed. Other patients might experience:

• Bone or joint pain

• Depression

• Forgetfulness

• Fatigue

• Kidney stones

• Fragile bones in the limbs and spine

• Excessive urine

• Nausea and loss of appetite

Other medical conditions may cause the symptoms, though, so always consult your doctor.

Hyperparathyroidism Diagnosis

Hyperparathyroidism is usually diagnosed with routine blood tests measuring the levels of parathyroid hormone (PTH), calcium and related minerals. Other possible tests and scans include:

• Urine Tests: Analyzing the urine during a 24-hour window can determine how much calcium the body is excreting.

• Bone Density Test: Looking at the bones detects any bone loss or weakening.

• X-ray, Ultrasound and Computed Tomography Scan (CT or CAT scan): Scans can identify blockages caused by excess calcium and any bone fractures.

Hyperparathyroidism Treatment

Treatments for hyperparathyroidism depend on:

• The suspected cause

• The severity of your symptoms

• Your preferences

Patients with modestly increased calcium and no symptoms may choose to hold off on interventions and instead visit us for regular checkups and careful monitoring, an approach called “watchful waiting.” Your doctor might also recommend precautions such as:

• Taking medication (if the hyperparathyroidism is due to kidney problems)

• Drinking more fluids to prevent kidney stones

• Exercising

• Getting extra vitamin D or calcium

Some kidney failure patients may need dialysis or a transplant. For more severe cases of primary hyperparathyroidism, your doctor may recommend surgically removing overactive glands and any tumors present.

Before surgery, your doctor could decide to pinpoint the problematic gland with:

• Sestamibi Scan: injecting a special radioactive compound for absorption by the overactive gland, then giving a computerized tomography (CT or CAT) scan to locate it

• Ultrasound