Learn About Hyperparathyroidism
Hyperparathyroidism is a condition in which 1 or more of the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
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There are 4 tiny parathyroid glands in the neck, near or attached to the back side of the thyroid gland.
The parathyroid glands help regulate calcium absorption, use and removal by the body. They do this by producing parathyroid hormone (PTH). PTH helps regulate calcium, phosphorus, and vitamin D levels in the blood and bone. It is important for healthy bones.
When the blood calcium level is too low, the body responds by making more PTH. This causes the calcium level in the blood to rise.
If one or more of the parathyroid glands grow larger, it may lead to too much PTH. Most often, the cause is a benign tumor of the parathyroid glands (parathyroid adenoma). These benign tumors are common and happen without a known cause.
- The disease is most common in people over age 60, but it can also occur in younger adults. Hyperparathyroidism in childhood is very unusual.
- Women are more likely to be affected than men.
- Radiation to the head and neck increases the risk.
- Some genetic syndromes (multiple endocrine neoplasia I) make it more likely to have hyperparathyroidism.
- In very rare cases, hyperparathyroidism is caused by parathyroid cancer.
Medical conditions that cause low blood calcium or increased phosphate can also lead to hyperparathyroidism. Common conditions include:
- Conditions that make it hard for the body to remove phosphate
- Kidney damage or failure
- Not enough calcium in the diet
- Too much calcium lost in the urine
- Vitamin D disorders (may occur in children who do not eat a variety of foods, and in older adults who do not get enough sunlight on their skin or who have poor absorption of vitamin D from food such as after bariatric surgery)
- Problems absorbing nutrients from food
Hyperparathyroidism is often diagnosed by common blood tests before symptoms occur.
Symptoms are mostly caused by damage to organs from high calcium level in the blood, or by the loss of calcium from the bones. Symptoms can include:
- Bone pain or tenderness
- Depression and forgetfulness
- Feeling tired, ill, and weak
- Fragile bones of the limbs and spine that can break easily
- Increased amount of urine produced and needing to urinate more often
- Kidney stones
- Nausea and loss of appetite
If you have a mildly increased calcium level and don't have symptoms, you may choose to have regular checkups or get treated.
If you decide to have treatment, it may include:
- Drinking more fluids to prevent kidney stones from forming
- Exercising
- Not taking a type of water pill called thiazide diuretic
- Estrogen for women who have gone through menopause
- Having surgery to remove the overactive glands
If you have symptoms or your blood calcium level is very high, you may need surgery to remove the parathyroid gland that is producing too much PTH.
If you have hyperparathyroidism from a medical condition, your provider may prescribe vitamin D, if you have a low vitamin D level.
If hyperparathyroidism is caused by kidney disease or failure, treatment may include:
- Extra calcium and vitamin D
- Avoiding phosphate in the diet
- The medicine cinacalcet (Sensipar)
- Dialysis or a kidney transplant
- Parathyroid surgery, if the PTH level becomes uncontrollably high
NewYork Presbyterian Columbia University Irving Medical Center
John Bilezikian is an Internal Medicine provider in New York, New York. Dr. Bilezikian is rated as an Elite provider by MediFind in the treatment of Hyperparathyroidism. His top areas of expertise are Hyperparathyroidism, Hypoparathyroidism, Hypercalcemia, Parathyroidectomy, and Hormone Replacement Therapy (HRT).
Cleveland Clinic Main Campus
Eren Berber is a General Surgeon in Cleveland, Ohio. Dr. Berber is rated as an Elite provider by MediFind in the treatment of Hyperparathyroidism. His top areas of expertise are Thyroid Cancer, Hyperparathyroidism, Pheochromocytoma, Thyroidectomy, and Parathyroidectomy.
Johns Hopkins Outpatient Center
Aarti Mathur, M.D., FACS, is an experienced, fellowship-trained endocrine surgeon in the Johns Hopkins Division of Surgical Oncology and an associate professor of surgery at the Johns Hopkins University School of Medicine. Dr. Mathur sees patients at The Johns Hopkins Hospital in Baltimore and at Sibley Memorial Hospital in Washington, D.C. Dr. Mathur earned her medical degree at the University of Texas. She completed a general surgery residency at MedStar Georgetown University Hospital, followed by fellowships at the National Cancer Institute, where she studied immunotherapy and surgical oncology for several years, performed endocrine surgery research and cared for patients with advanced oncologic diseases. Dr. Mathur also completed a fellowship in endocrine surgery at the Johns Hopkins University School of Medicine. Dr. Mathur’s practice exclusively focuses on surgical management of benign and malignant diseases of the thyroid, parathyroid, adrenal glands and cervical lymph nodes. Her expertise includes thyroid surgery for nodules, goiters, Graves disease, thyroid cancer and minimally invasive parathyroidectomy, surgery for persistent or recurrent hyperparathyroidism and laparoscopic adrenalectomy. She believes in providing state of the art, patient-centered multi-disciplinary care for complex endocrine surgical issues. Dr. Mathur serves on multiple committees of major national societies including the American Association of Endocrine Surgeons, the American Thyroid Association, and the American College of Surgeons. As a surgeon-scientist, Dr. Mathur directs a research group, funded by the National Institutes of Health, that studies voice and swallowing outcomes after thyroidectomy in older adults. Her research also focuses on understanding the link between hyperparathyroidism and other health conditions including cognitive impairment, cardiovascular disease and post-transplant outcomes. Dr. Mathur has numerous prestigious national research awards and grants, and she has published over 50 peer reviewed articles, reviews and book chapters. She is frequently invited to present her research at national and international meetings. Dr. Mathur is rated as an Elite provider by MediFind in the treatment of Hyperparathyroidism. Her top areas of expertise are Hyperparathyroidism, Familial Isolated Hyperparathyroidism, Parathyroid Hyperplasia, Parathyroidectomy, and Thyroidectomy.
Outlook depends on the cause of hyperparathyroidism.
Long-term problems that can occur when hyperparathyroidism is not well controlled include:
- Bones become weak, deformed, or can break
- High blood pressure and heart disease
- Kidney stones
- Long-term kidney disease
Parathyroid gland surgery can result in hypoparathyroidism and damage to the nerves that control the vocal cords.
Summary: To evaluate the potential usefulness of 11C/18F-MET/FET positron emission tomography/ computed tomography (PET/CT) for the diagnosis of primary and metastatic lesions in various amino acid transporter system (AATS)-related disease patients.
Summary: The proposed pilot feeding study aims to explore novel pathways in phosphate metabolism and identify new biomarkers, as well as to develop a compound index for assessing phosphate overload with high validity and reliability. Investigators will address the following specific aims: 1). To explore novel pathways of phosphate metabolism and assess the influence of CKD status on these metabolic pathway...
Published Date: May 20, 2024
Published By: Sandeep K. Dhaliwal, MD, board-certified in Diabetes, Endocrinology, and Metabolism, Springfield, VA. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
Reid LM, Kamani D, Randolph GW. Management of parathyroid disorders. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 123.
Thakker RV. The parathyroid glands, hypercalcemia and hypocalcemia. In: Goldman L, Cooney KA, eds. Goldman-Cecil Medicine. 27th ed. Philadelphia, PA: Elsevier; 2024:chap 227.
Walker MD, Bilezikian JP. Primary hyperparathyroidism. In: Robertson RP, ed. DeGroot's Endocrinology. 8th ed. Philadelphia, PA: Elsevier; 2023:chap 54.