What is hyperparathyroidism?
Hyperparathyroidism or hyperparathyroidism is a condition in which the parathyroid glands, located near or behind the thyroid gland, secrete too much parathyroid hormone (PTH). This hormone plays an important role in regulating calcium, phosphorus and vitamin D levels in blood and bones. An excessive increase in PTH leads to an increase in the level of calcium in the blood (hypercalcemia) and complications related to it. Parathyroid surgery is one of the treatments for this disease. In the following article, we will do a comprehensive and detailed review of hyperparathyroidism.
Symptoms of hyperparathyroidism
Hyperparathyroidism can lead to a wide range of symptoms caused by increased levels of calcium in the blood (hypercalcemia) and its effects on the body. These symptoms can be general or specific symptoms. For this reason, diagnosing the disease may be challenging.
In the following, we have mentioned the most common symptoms of this disease:
General symptoms
- Fatigue and weakness: People with hyperparathyroidism usually complain of chronic fatigue and general body weakness.
- Depression and mood changes: This disease can cause depression, anxiety and mood changes.
Specific gastrointestinal symptoms
- Nausea and vomiting: Increased calcium levels may cause nausea and vomiting.
- Constipation: Many patients suffer from chronic constipation.
- Decreased appetite: Decreased appetite and weight loss may also occur.
Specific renal symptoms
Excessive thirst and urination: Increased blood calcium can cause increased thirst and excessive urination (polyuria).
- Kidney stones: The formation of kidney stones due to increased calcium in the urine is a common symptom.
- Kidney failure: In severe cases, it may lead to kidney failure.
Specific skeletal and muscular symptoms
- Bone and joint pains: increased calcium levels can lead to bone and joint pains.
- Muscle weakness: Muscle weakness and pain may also be present.
Decreased bone density: hyperparathyroidism can lead to decreased bone density (osteopenia or osteoporosis) and increased risk of bone fractures.
Specific cardiovascular symptoms
Increased heart rate: Increased calcium can lead to increased heart rate and in severe cases, lead to cardiac arrhythmia.
- High blood pressure: High blood pressure can also be one of the complications of this disease.
Specific neurological symptoms
- Memory and concentration disorders: Patients may complain of memory and concentration problems.
- Headache: chronic headaches can also be one of the symptoms.
Causes of hyperparathyroidism
Hyperparathyroidism is divided into two main types, primary and secondary, each of which has its own causes. That is, it can be caused by direct problems in the parathyroid glands themselves (primary hyperparathyroidism) or caused by other disorders that affect blood calcium levels (secondary hyperparathyroidism). In the following, we will examine the causes of each of these two types:
Cause of primary hyperparathyroidism
This disease occurs due to direct problems in the parathyroid glands themselves. The main causes of this type are:
- Parathyroid adenoma: This is the most common cause of primary hyperparathyroidism and involves a benign tumor in one of the parathyroid glands that leads to excessive production of parathyroid hormone (PTH).
- Hyperplasia of parathyroid glands: excessive and abnormal growth of all four parathyroid glands, which increases the production of PTH hormone.
- Parathyroid carcinoma: cancerous tumors of the parathyroid glands that, although rare, can cause primary hyperparathyroidism.
- Multiple Endocrine Neoplasia Type 1 (MEN1): A rare genetic disorder that results in the formation of benign or malignant tumors in the endocrine glands, including the parathyroid glands.
Cause of secondary hyperparathyroidism
This type of disease is caused by other medical problems that decrease the level of calcium in the blood, and as a result, the parathyroid glands produce more hormones to compensate. The main causes of this type are:
- Chronic kidney diseases: the most common cause of hyperparathyroidism is secondary. Kidney failure reduces the body’s ability to excrete phosphorus and activate vitamin D, which leads to a decrease in calcium levels in the blood and stimulation of the parathyroid glands.
- Vitamin D deficiency: Vitamin D is necessary for the absorption of calcium from the intestine. Long-term vitamin D deficiency can cause a decrease in calcium levels in the blood and stimulate the parathyroid glands to overproduce PTH.
- Calcium Absorption Disorders: Diseases such as celiac disease or other digestive disorders that impair calcium absorption can cause decreased calcium levels and, as a result, secondary hyperparathyroidism.
- Vitamin D deficiency caused by insufficient intake or lack of exposure to sunlight: Vitamin D deficiency can cause a decrease in blood calcium levels and stimulate the parathyroid glands.
What people are more at risk of hyperparathyroidism?
Hyperparathyroidism occurs due to excessive production of parathyroid hormone (PTH) from the parathyroid glands. This disease can appear in both primary and secondary forms. Some people are more at risk of contracting this disease due to certain conditions and factors. In the following, these factors have been comprehensively examined:
Postmenopausal women: Women, especially after menopause, are at greater risk of primary hyperparathyroidism. This can be due to hormonal changes and a decrease in estrogen levels during this period.
Family history of endocrine disorders: Having a family history of hyperparathyroidism or other endocrine disorders such as multiple endocrine neoplasia type 1 (MEN1) can increase your risk.
Chronic kidney diseases: People with chronic kidney diseases are more at risk of secondary hyperparathyroidism. Kidney failure can lead to low levels of calcium in the blood, which stimulates the parathyroid glands to overproduce PTH.
Long-term vitamin D deficiency: Vitamin D plays a vital role in calcium absorption and maintaining bone health. Long-term vitamin D deficiency can lead to low calcium levels in the blood and, as a result, stimulate excessive production of the hormone PTH.
Receiving radiation therapy in the neck area: People who have received radiation therapy in the neck area to treat cancer or other diseases are at higher risk of developing hyperparathyroidism. Radiation therapy can damage the parathyroid glands and cause them to malfunction.
Multiple Endocrine Neoplasia Type 1 (MEN1): This rare genetic disease can cause benign or malignant tumors to grow in the endocrine glands, including the parathyroid glands.
Excessive calcium intake: Improper use of calcium supplements can increase blood calcium levels and stimulate PTH hormone production.
Lithium drug use: Lithium drug, which is used to treat bipolar disorders, can increase the level of PTH hormone and hyperparathyroidism.
Malnutrition: A lack of specific nutrients can disrupt the balance of calcium and phosphorus in the body and increase the risk of hyperparathyroidism.
How to diagnose hyperparathyroidism
Diagnosing an overactive parathyroid gland (hyperparathyroidism) involves a combination of clinical evaluation, blood tests, and medical imaging. The different stages and methods of diagnosing this disease are explained below:
Medical history and clinical examination
- Medical interview: The doctor talks with the patient about the symptoms, family history, related diseases and any medications.
- Physical examination: The doctor will check for physical symptoms associated with hyperparathyroidism, such as bone tenderness or osteoporosis, signs of kidney stones, and muscle weakness.
Blood tests
- Blood calcium level: An increase in blood calcium level (hypercalcemia) is a main symptom of hyperparathyroidism.
- Parathyroid hormone (PTH) level: Elevated PTH level indicates overactive parathyroid glands.
- Blood phosphorus level: Low blood phosphorus level may also be due to hyperparathyroidism.
- Vitamin D level: Evaluation of vitamin D level to detect vitamin D deficiency or insufficiency, which can be the cause of secondary hyperparathyroidism.
Urine test
24-hour urine calcium test: This test is used to measure the amount of calcium excreted in the urine during 24 hours. The results can help distinguish primary hyperparathyroidism from other disorders.
Medical imaging
- Thyroid and parathyroid ultrasound: used to check the size and structure of the parathyroid glands and identify adenomas or other abnormalities.
- Sestamibi parathyroid scan: A nuclear scan that uses radioactive material to detect parathyroid tumors.
- CT scan or MRI: In more complex cases, these scans may be used to more closely examine the parathyroid glands and their surrounding areas.
Other specialized tests
- Measurement of calcium level in bones: Bone densitometry (DXA) is performed to evaluate bone density and determine the amount of reduction in bone density.
- Genetic testing: In rare cases where genetic disorders such as multiple endocrine neoplasia type 1 (MEN1) are suspected, genetic testing is done.
Treatment of hyperparathyroidism
The treatment of hyperparathyroidism depends on the type of disease (primary or secondary hyperparathyroidism), the severity of the symptoms and the general condition of the patient. Treatment options include lifestyle changes, medications, and surgical procedures. In the following, these treatment methods will be examined:
Treatment of primary hyperparathyroidism
Parathyroid surgery
- Parathyroid adenoma removal: Surgery to remove a benign tumor (adenoma) from the parathyroid glands is usually the main treatment for primary hyperparathyroidism.
- Parathyroid hyperplasia: In cases where all of the parathyroid glands are enlarged, surgery may involve removing some of the glands.
Dr. Seyed Ahmed Fanai is a thyroid and parathyroid surgeon with more than 20 years of surgical experience and 5000 successful surgeries. He is an active member of the American Thyroid Association and performs thyroid and parathyroid surgeries with the most up-to-date medical equipment. Contact us to schedule an appointment.
taking medicine
- Calcimimetics (such as cinaclest): These drugs help by reducing the production of parathyroid hormone (PTH) and lowering blood calcium levels. These drugs are usually used for inoperable patients or as temporary treatment.
- Bisphosphonates (such as alendronite and ibandronite): These drugs help reduce bone breakdown and reduce blood calcium levels.
- Vitamin D and calcium supplements: if needed to control the calcium level and improve the condition of the bones.
Treatment of secondary hyperparathyroidism
Treatment of the underlying cause
- Chronic kidney disease: Treatment of the underlying kidney disease, such as dialysis or a kidney transplant, can help reduce hyperparathyroidism.
- Vitamin D deficiency: Vitamin D supplements are used to eliminate deficiency and improve calcium absorption and reduce parathyroid levels.
taking medicine
- Calcimimetics (such as cinaclist): Similar to the treatment of primary hyperparathyroidism, these drugs can be used to reduce PTH production and control calcium levels.
- Bisphosphonates: to reduce the risks of increased bone resorption in chronic kidney disease.
Nutritional management
- Diet: reducing calcium and phosphorus intake can help in some cases, especially in chronic kidney disease.
- Dialysis: for patients with kidney failure who need more accurate control of calcium and phosphorus levels.
Auxiliary methods
- Water therapy: drinking enough fluids to prevent the formation of kidney stones.
- Physical activity: regular exercise to maintain bone health and reduce muscle symptoms.
Complications of hyperparathyroidism
An overactive parathyroid (hyperparathyroidism) can lead to a number of complications and serious health problems. These complications arise due to the increase in the level of parathyroid hormone (PTH) and its effect on calcium and phosphorus in the body. In the following, the common and serious complications of this disease will be discussed:
bone problems
- Decreased bone density: Increased PTH levels cause excessive bone breakdown and decreased bone density (osteopenia or osteoporosis), which can lead to easier fractures and chronic bone pain.
- Bone and joint pains: pain in bones and joints can be caused by reduced density and bone changes.
kidney problems
- Kidney stones: Increased calcium levels in the blood can lead to the formation of kidney stones, which can cause severe pain and urinary problems.
- Renal failure: In severe cases and without treatment, hyperparathyroidism can lead to kidney failure.
heart problems
- Increased blood pressure: hyperparathyroidism can lead to increased blood pressure and increased risk of heart diseases.
- Cardiac arrhythmias: High calcium levels can affect heart function and lead to arrhythmias or irregular heartbeats.
Digestive problems
- Nausea and vomiting: Increased blood calcium can lead to digestive problems such as nausea, vomiting and loss of appetite.
- Constipation: Patients may suffer from chronic constipation, which can affect quality of life.
Nervous and mental problems
- Muscle weakness and fatigue: Muscle weakness and chronic fatigue are common symptoms.
- Memory and concentration problems: Memory problems, concentration and mood changes may occur due to the effect of high calcium levels on the nervous system.
Specific bone problems
“Kidney, bone, and stone” syndrome: This syndrome includes kidney stones, decreased bone density, and other problems associated with high calcium levels.
Problems in pregnancy
Risks for the mother and the fetus: If not properly controlled, hyperparathyroidism can lead to complications for the mother and the fetus during pregnancy, including fetal growth disorders and delivery problems.
Prevention of hyperparathyroidism
Prevention of hyperparathyroidism, especially by focusing on modifiable risk factors and managing underlying diseases associated with this disorder, can help reduce the likelihood of this disease occurring. Here are some ways to prevent hyperparathyroidism:
Management of the disease state
- Chronic kidney disease control: For people with chronic kidney disease, proper management and treatment of these diseases can help reduce the risk of secondary hyperparathyroidism. Dialysis and kidney transplant can be effective in cases of kidney failure.
- Adequate supply of vitamin D: Vitamin D supplements and regular exposure to sunlight are important to prevent vitamin D deficiency and reduce the risk of secondary hyperparathyroidism.
Adhering to diet and making lifestyle changes
- Balanced diet: Sufficient consumption of calcium and phosphorus in the diet can help maintain the balance of these minerals and prevent problems related to the parathyroid glands.
- Avoiding excessive consumption of calcium and supplements: Excessive use of calcium supplements can lead to an increased risk of hyperparathyroidism. Therefore, the consumption of these supplements should be under the supervision of a doctor and based on the actual needs of the body.
Monitoring and regular visits to the doctor
- Regular checkups: Regular medical checkups and tests for calcium and PTH levels in people who are at risk for hyperparathyroidism, such as those with a family history or kidney problems, can help with early detection and preventative treatment.
- Follow-up for genetic diseases: For people with a family history of endocrine disorders, genetic counseling and regular screenings can help with early detection and management.
Avoiding radiation therapy in the neck area
Careful management of radiation treatments: If radiation therapy is needed in the neck area to treat cancer or other diseases, preventive measures and regular examinations to monitor the health of the parathyroid glands are recommended.
Education and awareness
Awareness of the early symptoms: Awareness of the symptoms of hyperparathyroidism such as fatigue, bone pain, and digestive problems can help in early detection of the disease and prompt treatment.
FAQ
Primary hyperparathyroidism, which is often caused by a benign tumor or hyperplasia of the parathyroid glands, is usually treated with surgery. If the surgery is successful, the disease will be permanently cured. Hyperparathyroidism is secondary to other medical conditions and may improve with treatment of the underlying cause.
For the treatment of hyperparathyroidism, calcium mimetics such as cinaclest are prescribed to reduce the production of parathyroid hormone and reduce the level of calcium in the blood. Bisphosphonates such as alendronate and ibandronate also help reduce bone breakdown and manage calcium levels. In some cases, vitamin D supplements are used to regulate calcium and phosphorus levels.
Primary hyperparathyroidism is mostly unpreventable due to genetic causes and benign tumors. However, secondary hyperparathyroidism caused by chronic kidney disease or vitamin D deficiency can be prevented to some extent by proper management of these conditions and adequate intake of vitamin D and calcium. Following a balanced diet and maintaining overall health can help.
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