Hyperparathyroidism

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What is hyperparathyroidism?

Hyperparathyroidism is the excessive production of parathyroid hormone by your parathyroid glands, which results in changes in your calcium and phosphorous levels. Parathyroid glands are located on or near the thyroid gland in your neck and are responsible for the regulation of calcium and phosphorous levels in your body. Despite the proximity of the thyroid and parathyroid glands, they serve distinct functions. Properly functioning parathyroid glands are required to sustain life. Fortunately, treatment is possible for overactive or underactive parathyroid glands.

Overactive parathyroid glands (primary hyperparathyroidism) signal your body to increase the level of calcium in the blood by decreasing your excretion of calcium. More seriously, calcium may be harvested from the calcium in your bones. Mild hyperparathyroidism can often be treated simply by increasing your fluid intake, though more serious hyperparathyroidism may require surgical removal of one of the over-functioning parathyroid glands.

High parathyroid levels are a normal body response to low blood calcium levels (known as secondary hyperparathyroidism). Renal (kidney) failure is the most common cause of secondary hyperparathyroidism.

Your physician or health care professional can easily and quickly determine your levels of calcium, phosphorous, and parathyroid hormone with a simple blood test. These tests can also determine what type of hyperparathyroidism (primary or secondary) you may have.

Seek prompt medical care if you are being treated for hyperparathyroidism but have mild symptoms that recur or are persistent. Seek immediate medical care (call 911) for serious symptoms, including coma; change in behavior, such as confusion, hallucinations or delirium; or severe abdominal pain, as these could be signs of a life-threatening condition.

What are the symptoms of hyperparathyroidism?

Symptoms of hyperparathyroidism include effects on your bones due to absorption of calcium from bone, including brittle or weakened bones, bone pain, or lower back pain. Systemic symptoms related to hyperparathyroidism include thirst, increased urination, depression, personality changes, and loss of appetite, among others. Life-threatening symptoms associated with hyperparathyroidism include coma, stupor, or severe bone weakness and fractures.

Common symptoms of mild hyperparathyroidism

You may experience hyperparathyroidism symptoms daily or just once in a while. Many people with hyperparathyroidism do not even notice any symptoms, though at times any of these symptoms can be severe:

  • Abdominal pain
  • Bone, joint, or lower back pain
  • Changes in mood, personality or behavior
  • Fatigue
  • Increased thirst
  • Increased urine volume
  • Itching feeling
  • Muscle weakness or muscle soreness

Common symptoms of more severe hyperparathyroidism

In addition to all of the symptoms of mild hyperparathyroidism, you may experience symptoms of severe hyperparathyroidism including:

  • Abdominal pain
  • Bone fractures
  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Constipation
  • Difficulty with memory, thinking, talking, comprehension, writing or reading
  • Kidney stones
  • Loss of appetite
  • Loss of height
  • Nausea with or without vomiting

Serious symptoms that might indicate a life-threatening condition

In some cases, hyperparathyroidism can be life threatening if calcium levels get too high in your blood. Seek immediate medical care (call 911) if you, or someone you are with, have any of these life-threatening symptoms including:

  • Bone fractures, especially in the elderly
  • Change in level of consciousness or alertness, such as passing out or unresponsiveness
  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations or delusions
  • Coma
  • Severe abdominal pain

What causes hyperparathyroidism?

Primary hyperparathyroidism is caused by overproduction of parathyroid hormone. The cause the disease is not known in most cases. Rare causes of primary hyperparathyroidism include parathyroid cancer or inherited disorders.

Secondary hyperparathyroidism is caused by low levels of calcium in the blood. The most common cause is kidney failure. Other causes include gastrointestinal conditions that interfere with calcium absorption or low levels of vitamin D. Treatment of the underlying cause of secondary hyperparathyroidism usually results in normal parathyroid hormone levels.

What are the risk factors for hyperparathyroidism?

A number of factors increase the risk of developing hyperparathyroidism. Not all people with risk factors will get hyperparathyroidism. Risk factors for hyperparathyroidism include:

  • Advanced age (generally older than 60 years, although the disease may occur in young adults in rare cases)

  • Family history of familial hypocalciuric hypercalcemia (high calcium levels in the blood along with low levels of calcium in the urine)

  • Family history of familial multiple endocrine neoplasia type 1 (rare disease characterized by tumors in the endocrine glands and part of the small intestine)

  • Vitamin D deficiency

How is hyperparathyroidism treated?

Mild hyperparathyroidism may have only minor symptoms or no apparent symptoms at all. In these cases, you may be able to live normally with the condition, although regular visits to your physician to monitor your levels of calcium and parathyroid hormone are important. Secondary hyperparathyroidism usually resolves with treatment of the underlying cause of your low calcium levels.

Severe hyperparathyroidism is treatable only with surgery to remove the specific parathyroid gland that is overproducing parathyroid hormone. Additionally, it is important to consume plenty of fluids to decrease your risk of complications, such as kidney stones. Some drugs should be avoided, such as thiazide diuretics, which are often used to treat high blood pressure or fluid retention.

Treatment of mild primary hyperparathyroidism

Treatment of mild primary hyperparathyroidism includes preventive measures and regular visits to your health care professional to monitor your condition. Treatment measures include:

  • Avoiding thiazide diuretics
  • Drinking plenty of water to prevent kidney stones associated with hyperparathyroidism
  • Getting regular exercise
  • Taking estrogen therapy (in postmenopausal women)

Treatment of secondary hyperparathyroidism

Secondary hyperparathyroidism is your body’s natural response to low calcium levels in your blood. Treatment of secondary hyperparathyroidism centers on determining the underlying cause of low calcium levels. Treatment depends on the underlying cause of low calcium, but it may include:

  • Avoiding certain metals, such as aluminum, which may be present in supplements
  • Increasing calcium in your diet
  • Increasing your intake of vitamin D or increasing your exposure to sunlight
  • Treating any disorder that may interfere with calcium absorption in your intestines
  • Treating underlying cancer
  • Treating underlying kidney disease

Treatment of severe hyperparathyroidism

In addition to the treatment for mild hyperparathyroidism, severe hyperparathyroidism may require surgery to remove the affected parathyroid tissue. Most people have about four parathyroid glands, and often only a single gland is overactive. In these cases, surgeons can simply remove the affected parathyroid gland while leaving the other glands intact.

A new class of drugs, called calcimimetics, may be useful in decreasing your body’s production of parathyroid hormone, although they are not currently approved for primary hyperparathyroidism. You can discuss these types of medications with your physician for more information.

What you can do to improve your hyperparathyroidism

You may be able to avoid or improve hyperparathyroidism by:

  • Drinking lots of water to avoid kidney stones
  • Exercising regularly to build your bone and muscle strength
  • Eating a balanced diet, including calcium
  • Getting adequate exposure to the sun

What are the potential complications of hyperparathyroidism?

Hyperparathyroidism or its surgical treatment can result in a variety of complications. Left untreated, hyperparathyroidism can result in serious fractures or life-threatening coma. You can help minimize your risk of serious complications by following the treatment plan you and your health care professional design specifically for you. Complications of hyperparathyroidism include:

  • Damage to nerves controlling your vocal cords as a rare complication of surgical treatment of hyperparathyroidism
  • Fractures
  • Hypocalcemia (low calcium levels, a rare, potentially serious complication of surgical treatment of hyperparathyroidism)
  • Kidney stones or urinary tract infections
  • Pancreatitis
  • Pseudogout (buildup of calcium salt crystals in the joints)
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2020 Oct 31
THIS TOOL DOES NOT PROVIDE MEDICAL ADVICE. It is intended for informational purposes only. It is not a substitute for professional medical advice, diagnosis or treatment. Never ignore professional medical advice in seeking treatment because of something you have read on the site. If you think you may have a medical emergency, immediately call your doctor or dial 911.
  1. Hyperparathyroidism. National Endocrine and Metabolic Diseases Information Service. http://endocrine.niddk.nih.gov/pubs/hyper/hyper.htm
  2. Hyperparathyroidism. PubMed Health. http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002195/