Hyperparathyroidism Causes & Treatment Options

What Are Parathyroid Glands?

Unless you have parathyroid disease or know someone who has it, chances are you have never heard of the parathyroid glands, i.e. four small parathyroid glands in the lower part of the neck behind the thyroid gland (parathyroid means next to thyroid) to the side of the breathing tube (trachea). The parathyroid glands are hormone-producing glands, and they are part of the endocrine system.

Parathyroid glands are constantly working to regulate calcium levels in the body. Calcium is a vital nutrient used by every cell in the body for normal daily functions. If calcium levels are not at the optimal levels, a variety of problems can occur, including:

If your calcium levels are low, every cell and organ in the body will be inefficient and not function properly, which is why so many symptoms can occur with hyperparathyroidism.

The parathyroid hormone (PTH) eventually enters the bones and activates the cells that reabsorb and remodel the bone, thereby releasing calcium into the blood.
PTH will also instruct the kidneys to absorb calcium back from urine.
Finally, PTH changes vitamin D to its active form, which helps the intestines absorb calcium from food and increases calcium levels in the blood.

When a patient develops primary hyperparathyroidism, this process is disrupted.

What Is Primary Hyperparathyroidism?

The majority of the time, a parathyroid tumor is located in one of the four parathyroid glands. It is usually a benign tumor, called a parathyroid adenoma, which grows to an abnormal size. As a parathyroid tumor grows, it releases greater amounts of PTH, thus causing Primary hyperparathyroidism (PHPT).

Simply put, PHPT refers to a condition that causes an excess of PTH in the bloodstream due to overactivity of one or more of the parathyroid glands. It is the most common disease that affects the parathyroid glands, and it takes a toll on the entire body.

What Are the Causes of Hyperparathyroidism?

Hyperparathyroidism causes include :

Secondary hyperparathyroidism, a condition that causes the parathyroid glands to overwork secondary to another medical issue, may also occur. Common reasons why people experience secondary hyperparathyroidism include:

Furthermore, people may be more prone than others to primary or secondary hyperparathyroidism if they fall into any of the following categories:

Who Gets Hyperparathyroidism?

In the United States, Approximately 100,000 new cases of PHPT are diagnosed every year. More specifically, one in every 800 people has PHPT, with the disease being more common in women, affecting one in every 250 women over the age of 60. The majority of people dealing with PHPT go undiagnosed or are misdiagnosed, as it is a complex or confusing disease for inexperienced physicians. However, there is a lot of data that the incidence is much more: In a Canadian multicenter oseoporosis study where adults over the age of 35 were assessed; 1.4% were found to have primary hyperparathyroidism, and 3.3% normocalcemic hyperparathyoidism. Which makes the incidence closer to one in 20 adults.

Hyperparathyroidism Symptoms

Almost all hyperparathyroidism patients experience symptoms of the disease. However, one o the reasons that so many hyperparathyroidism patients go undiagnosed or are misdiagnosed is that the symptoms are wide-ranging, not necessarily overwhelming, and can be associated with several other diseases. Additionally, hyperparathyroidism affects every patient differently, making the disease hard to pinpoint for an inexperienced physician.

For example, some patients will experience signs and symptoms of hyperparathyroidism within the first year of having high elevated blood calcium levels, while others will go five or more years without any obvious or debilitating symptoms. Regardless of the presence or absence of symptoms, the disease is still destroying your body, and ultimately decreases your life expectancy if not treated. Luckily, the disease can be cured by removing the tumor with a minimally invasive procedure that usually takes less than 20 minutes.

I struggled unsuccessfully for months to find a local surgeon who could diagnose my hyperparathyroidism, and was fortunate enough to learn about Dr. Larian while doing my own research. Few doctors are knowledgeable about parathyroid disease, even fewer can perform the surgery successfully using minimally invasive procedures.” – Jennifer, Washington DC

Every cell in our body uses calcium to function correctly; therefore, having high calcium levels can cause a variety of symptoms. However, it is important to understand that the severity of symptoms does not necessarily correlate to the calcium level. This means you do not need to have elevated calcium levels to experience extreme symptoms, and, vice versa, you may have high levels of calcium with little to no symptoms.

A parathyroid patient may feel old and experience body aches. For some patients, these symptoms are stronger. And, for others, these symptoms are less pronounced. Because the spectrum of symptoms of hyperparathyroidism is so diverse and patients can experience any combination of symptoms, a lot of patients are not properly diagnosed as having a parathyroid disorder, and they continue to live in pain and discomfort. This is why it is crucial to find a parathyroid expert, like Dr. Larian, to correctly diagnose and treat the disease.

The overt symptoms of PHPT are generally, but not unanimously, considered to be:

Below is a more detailed list of the symptoms hyperparathyroid patients may suffer from as a result of the disease:

● Chronic fatigue
1. Decreased energy levels
2. Don’t feel like leaving the house and participating in activities they used to enjoy
3. Always tired
● Just don’t feel like yourself
1. Never feel 100% well
2. Don’t feel “normal” anymore
3. It is hard to explain to others, but you know you don’t feel right
● Feel old
1. You are getting older, so this must be what it feels like to age?
2. Maybe it is just menopause?

● Brain Fog
1. Cognitive dysfunction
2. You can’t concentrate on simple tasks or big projects
3. Mental fogginess
4. Forgetfulness — you find yourself forgetting things easily
● More irritable than usual
1. You aren’t as happy as you used to be
● Depression
● Anxiety
● Recurring headaches
● Poor sleep
1. You don’t sleep as well as you previously did
2. You can’t sleep through the night and/or wake up several times during the night
3. You have trouble falling asleep
● Osteoporosis and osteopenia
● Bone pain
● Bone fractures
● Muscle weakness
● Gastrointestinal problems
1. Acid reflux
2. Heartburn
3. GERD
4. Constipation
5. Peptic ulcer disease (stomach ulcer)
6. Anorexia
7. Acute pancreatitis
8. Abdominal pain (stomach aches)
● Decreased libido (sex drive)
● Kidney stones
1. Can potentially lead to kidney failure
● Frequent urination
● Excessive nighttime urination
● Heart palpitations (arrhythmias)
● High blood pressure

Long-standing elevated calcium levels place a heavy burden on your body. Parathyroid disease only gets worse with time, and it will not improve on its own. Studies have found that patients who do not have their parathyroid tumor removed experience a decrease in their life expectancy and may pass away due to kidney failure, heart failure, breast or prostate cancer, stroke, or heart attack. However, this does not need to be the case for you! When the parathyroid tumor is removed, the disease is completely cured in almost all cases.

“After years of vague symptoms and months of severe symptoms, just days after surgery I feel better than I have in such a long time.” – Jennifer

If your calcium levels are even slightly higher than normal, it is time to find a parathyroid specialist, like Dr. Larian, who can provide a proper diagnosis. Dr. Larian has unparalleled experience in diagnosing patients based on their PHPT symptoms and calcium levels, and he has seen countless manifestations of the disease. Many of Dr. Larian’s patients were previously undiagnosed or misdiagnosed by other physicians. But upon these patients’ first in-office or Skype consultations with Dr. Larian, they were able to be instantly diagnosed. Dr. Larian will not tell you that your calcium is “not that high” or to “wait a few more months or another year to see if the levels come down” because he knows the parathyroid tumor will not go away on its own, and therefore, there is no reason to delay treatment.

Are There Specific Calcium Treatments I Should Do if I Have Hyperparathyroidism?

Yes. Hyperparathyroidism increases the rate at which bone is lost in the body. If your
hyperparathyroidism has gone untreated for a prolonged period, you have an increased risk of
developing osteoporosis. The two treatment options are to remove the gland that has the
parathyroid tumor that overproduced PTH hormone. Or to use medications all your life to reduce the function of the parathyroid tumor, and another medicine to increase bone density (again to be used for a lifetime). Dr. Larian can advise you regarding the most effective calcium treatment.

How Likely Is It for Me to Get Kidney Stones If I Have Hyperparathyroidism?

It is likely, but hard to predict. The data is not clear. At the present time between 10-20% of people diagnosed with HPT have kidney stones. However, a great number of patients that have kidney stone due to HPT are not diagnosed because they may have normocalcemic HPT, and not have elevated blood calcium levels. If the doctor seeing you for kidney stones is not aware of the possibility of normal calcium levels being possible in hyperparathyroidism, then they could easily miss the possibility of hyperparathyroidism as the source of the kidney stones being developed.

Calcium in your blood is filtered by the kidneys. If there happens to be an excess of calcium (more then what your body wants) then the kidney is responsible to recognize that and filter it out. If there is a constant excess of calcium in the kidney then small elements of calcium can stick together and from a stone that can get stuck in the kidney or pass down the channels/ tubes (ureters) going to the bladder; this is a very painful experience (passing a kidney stone).

How Do I Handle Hyperthyroidism Without Surgery?

In addition to any medication prescribed by Dr. Larian, it is important that you get regular exercise. You should also engage in strength training to maintain bone health, consume plenty of fluids, avoid calcium-raising medications such as lithium or some diuretics, and avoid smoking.

Does hyperparathyroidism run in families?

Yes. Hyperparathyroidism is caused by mutations that occur in a parathyroid cell. This mutation can occur because of exposure to environmental toxins, or it can run in families. There are many versions of mutations that can cause HPT. Some that can show themselves in all or most members of a family, and some that are “weak” mutations and don’t show in all the people that have the mutation (so only some family members get HPT, not all).

Does parathyroid disease happen in connection with thyroid disease?

No with a small exception. The thyroid gland produces hormones that control the body’s metabolism. The parathyroid glands produce PTH that is mainly in charge of controlling calcium balance and vitamin D activation. They just happen to be next to each other. The diseases in thyroid and parathyroid don’t effect each other, or cause it in each other.

The exception is when people have a genetic disorder called MEN 2a (Multiple Endocrine Neoplasia 2a), which cause tumors to happen in both the thyroid gland (medullary thyroid cancer) and parathyroid gland (hyperparathyroidism).

Parathyroid Adenoma

The most common cause of hyperparathyroidism is a parathyroid tumor called parathyroid adenoma, and it is benign (non-cancerous) tumor. A parathyroid adenoma (or excess hormone producing parathyroid tumor) is a growth inside a parathyroid gland; this growth of abnormal cells produce excessive amounts of PTH. As a consequence of excess PTH the calcium levels in the blood increase, and this condition is known as hypercalcemia. While a single adenoma is most common, it is possible to have parathyroid adenomas on several glands.

While the vast majority of patients only have a single parathyroid adenoma, it is very important to still conduct a 4 gland assessment to guarantee the patient is cured. Whether you have one parathyroid adenoma, two or three parathyroid adenomas, the signs and symptoms will be the same. Symptoms are not necessarily more extreme when a patient has multiple adenomas, either.

Over time, the parathyroid tumor will continue to grow, and your parathyroid disease will get worse until the tumor is removed. At the same time, your remaining normal parathyroid glands will stop working (because the calcium is too high) and shrink in size. A parathyroid tumor will never go away on its own; it must be surgically removed. When performed by an expert parathyroid surgeon, like Dr. Larian, a minimally invasive parathyroidectomy is a quick and successful treatment for parathyroid tumors.

Parathyroid Hyperplasia

Parathyroid hyperplasia occurs when all the parathyroid glands, have all abnormal cells within them. This may occur secondary to other conditions: the most well known reasons for developing parathyroid hyperplasia is (1) complete kidney failure to the point of need to go on kidney dialysis (hemodialysis) (2) taking Lithium (medication) for a prolonged period of time.

Parathyroid hyperplasia can also occur in people who carry one of the many genes that can cause parathyroid hyperplasia, such as MEN 1 gene (Menin Protein Gene), or RET gene (causes MEN 2). When these genetic mutations are present, the person develops abnormalities in all the parathyroid cells in all of the parathyroid glands.

The abnormality causes not only the abnormal parathyroid cells to keep duplicating and growing but also produce extra PTH. In time, growth and production of PTH become too much for the body and then the person develops increased calcium levels in the bloodstream that persists. The symptoms of hyperparathyroidism develop more slowly and are more subtle because the body has more time to adapt. But the ultimate consequence is the same with bone loss, kidney stones and all the other symptoms occurring.

Interesting Parathyroid Adenoma Facts:

Primary hyperparathyroidism develops over a period of years
Calcium elevation usually plateaus with parathyroid adenomas, even though PTH levels continue to elevate.
Calcium levels do not correlate to the size of the parathyroid adenoma
The size and weight of abnormal parathyroid gland(s) is directly proportional to PTH levels and inversely proportional to vitamin D levels.
Degree and severity of hyperparathyroidism symptoms do not always correlate to calcium levels.
Bone mass density loss occurs with all forms of hyperparathyroidism, even normocalcemic hyperparathyroidism.
Bone mass density loss usually occurs if the disease is present for eight years or longer.

Hyperparathyroidism Causes & Treatment Options