Hyperparathyroidism
Parathyroid-related hypercalcemia; Osteoporosis - hyperparathyroidism; Bone thinning - hyperparathyroidism; Osteopenia - hyperparathyroidism; High calcium level - hyperparathyroidism; Chronic kidney disease - hyperparathyroidism; Kidney failure - hyperparathyroidism; Overactive parathyroid; Vitamin D deficiency - hyperparathyroidismHyperparathyroidism is a condition in which 1 or more of the parathyroid glands in your neck produce too much parathyroid hormone (PTH).
Causes
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.
Parathyroid adenoma
A parathyroid adenoma is a noncancerous (benign) tumor of the parathyroid glands. The parathyroid glands are located in the neck, near or attached t...
Read Article Now Book Mark Article- 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.
Multiple endocrine neoplasia I
Multiple endocrine neoplasia (MEN) type I is a disease in which one or more of the endocrine glands are overactive or forms a tumor. It is passed do...
Read Article Now Book Mark Article - In very rare cases, hyperparathyroidism is caused by parathyroid cancer.
Parathyroid cancer
Parathyroid cancer is a cancerous (malignant) growth in a parathyroid gland.
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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
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Kidney damage or failure
Kidney damage or failure
End-stage kidney disease (ESKD) is the last stage of long-term (chronic) kidney disease. This is when your kidneys can no longer support your body's...
Read Article Now Book Mark Article - 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
Symptoms
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:
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Bone pain or tenderness
Bone pain or tenderness
Bone pain or tenderness is aching or other discomfort in one or more bones.
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Depression and forgetfulness
Depression
Depression may be described as feeling sad, blue, unhappy, miserable, or down in the dumps. Most of us feel this way at one time or another for shor...
Read Article Now Book Mark Article - 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
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Kidney stones
Kidney stones
A kidney stone is a solid mass made up of tiny crystals. One or more stones can be in the kidney or ureter at the same time.
Read Article Now Book Mark Article - Nausea and loss of appetite
Exams and Tests
Your health care provider will do a physical exam and ask about symptoms.
Tests that may be done include:
- Creatinine, BUN (kidney function tests)
Kidney function tests
Kidney function tests are common lab tests used to evaluate how well the kidneys are working. Such tests include:BUN (Blood urea nitrogen) Creatinin...
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PTH blood test
PTH blood test
The PTH test measures the level of parathyroid hormone in the blood. PTH stands for parathyroid hormone. It is a protein hormone released by the par...
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Calcium blood test
Calcium blood test
The calcium blood test measures the level of calcium in the blood. This article discusses the test to measure the total amount of calcium in your blo...
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Alkaline phosphatase
Alkaline phosphatase
Alkaline phosphatase (ALP) is a protein found in all body tissues. Tissues with higher amounts of ALP include the liver, bile ducts, and bone. A blo...
Read Article Now Book Mark Article - Magnesium
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Phosphorus
Phosphorus
The phosphorus blood test measures the amount of phosphate in the blood.
Read Article Now Book Mark Article - Vitamin D
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24-hour urine test - done to determine how much calcium is being filtered out of the body into the urine
24-hour urine test
The urine 24-hour volume test measures the amount of urine produced in a day. The amounts of creatinine, protein, and other chemicals released into ...
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Other tests include:
- Bone density exam
- Kidney ultrasound or CT scan (may show kidney stones or calcification)
Ultrasound
Ultrasound uses high-frequency sound waves to make images of organs and structures inside the body.
Read Article Now Book Mark ArticleCT scan
A computed tomography (CT) scan is an imaging method that uses x-rays to create pictures of cross-sections of the body. Related tests include:Abdomin...
Read Article Now Book Mark Article - Kidney x-rays (may show kidney stones)
x-rays
X-rays are a type of electromagnetic radiation, just like visible light. An x-ray machine sends individual x-ray waves through the body. The images...
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- Neck ultrasound
- Sestamibi neck scan (to identify the location of the parathyroid adenoma)
Treatment
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
Outlook (Prognosis)
Outlook depends on the cause of hyperparathyroidism.
Possible Complications
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.
Hypoparathyroidism
Hypoparathyroidism is a disorder in which the parathyroid glands in the neck do not produce enough parathyroid hormone (PTH).
Read Article Now Book Mark ArticleReferences
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.
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Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
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Parathyroid glands - illustration
The 4 parathyroid glands are located near or attached to the back side of the thyroid gland and produce parathyroid hormone. Parathyroid hormone regulates calcium, phosphorus, and magnesium balance within the blood and bone by maintaining a balance between the mineral levels in the blood and the bone.
Parathyroid glands
illustration
Review Date: 5/20/2024
Reviewed 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.