Hyperparathyroidism presents unique challenges during pregnancy that can impact the lives and health of a mother and baby. Fortunately, the incidence of hyperparathyroidism in pregnant women is relatively small, affecting less than one percent of the entire population. However, as women are having babies later in life, the incidence of primary hyperparathyroidism in pregnancy could rise since the condition tends to strike older women.

Hyperparathyroidism may lead to dangerous complications both during pregnancy and after the baby is born. When it does occur, expert care is critical to ensure both the mother and baby survive safely.

What is Primary Hyperparathyroidism (And How Do I Know if I Have it)?

Primary hyperparathyroidism or PHPT is a condition in which calcium levels in the bloodstream become dangerously elevated. Normally, the parathyroid glands regulate calcium levels to ensure your body gets the exact amount necessary to function at optimal capacity. When one or more of the parathyroid glands become dysfunctional due to a benign tumor or enlargement of the gland, calcium levels begin to increase unchecked. This can lead to uncomfortable symptoms and affect major organs of the body.

Symptoms of PHPT include: 

  • Fatigue 
  • Difficulty concentrating
  • Memory issues
  • Weak or aching muscles
  • More frequent urination
  • Depression and anxiety
  • Stomach upset 
  • Weight loss (in advanced cases)

Some people do not experience any noticeable symptoms with PHPT, while others may not attribute their symptoms to high calcium levels. During pregnancy, many of these symptoms may be considered “normal” as well. A physician with expertise in the parathyroid gland is the best choice for diagnosing and treating this condition. 

The Impact of Primary Hyperparathyroidism in Pregnancy

Primary hyperparathyroidism in pregnancy is a serious problem that needs to be handled with extreme care by a team of medical experts. Studies have shown high miscarriage rates in women with PHPT, increasing as calcium levels increase. Some women who have had multiple miscarriages in the past may have undiagnosed PHPT contributing to the problem. The good news is once the PHPT is treated, miscarriage rates dramatically decline among these women. 

Even if the pregnancy progresses, women and their babies have an increased risk of complications such as: 

  • Preeclampsia and hypertension
  • HELLP syndrome
  • Increased amniotic fluid
  • Fetal growth restriction 
  • Preterm delivery
  • Stillbirth
  • Congenital abnormalities

PHPT can also lead to babies born with atrophied parathyroid glands of their own, or weak bones that are prone to fracture during the early years of life. To protect both mother and child during pregnancy and afterward, proper diagnosis and treatment of PHPT is critical.

Diagnosing Primary Hyperparathyroidism in Pregnancy

PHPT can usually be detected through serum calcium levels collected during normal bloodwork. Most people that have PHPT will have elevated calcium levels and an increase in parathyroid hormone (PTH). The parathyroid glands release this hormone when calcium levels drop to bring levels back up to the normal range quickly. When the parathyroid isn’t working properly, it can release too much PTH, which will raise calcium above the normal range.

Some patients may have elevated calcium levels without an increase in PTH, which is known as normohormonal PHPT. Others might have elevated PTH levels while the calcium amount is normal, a condition known as normocalcemic PHPT. Since PHPT is complex to diagnose, particularly during pregnancy, a physician that specializes in conditions of the parathyroid is recommended.

The Problem of Secondary Hyperparathyroidism and Pregnancy 

Different from primary hyperparathyroidism, secondary hyperparathyroidism is caused by another medical condition, such as a vitamin D deficiency. Lack of vitamin D results in less calcium being absorbed into the intestines, which can trigger the parathyroid to produce more PTH to increase calcium levels in the body. Pregnant women who don’t have enough vitamin D also run the risk for complications like preeclampsia and preterm birth. 

Fortunately, a vitamin D deficiency is relatively easy to diagnose and can be treated with dietary changes and supplementation. Once vitamin D levels return to the normal range, PTH and calcium levels will usually follow suit. 

Care and Treatment of Primary Hyperparathyroidism in Pregnancy 

Treatment of primary hyperparathyroidism during pregnancy must be weighed carefully to ensure the benefits to the mother and baby outweigh the risks. In most cases, surgery to remove the damaged parathyroid gland, an operation known as a parathyroidectomy, is the best way to address PHPT. 

The surgeon typically uses a 4D parathyroid CT scan to evaluate the parathyroid glands and localize the gland that needs to be removed. This scan involves the use of a contrast agent & the CT scan has radiation that is contraindicated during pregnancy due to potential harm to the fetus. Instead, ultrasound can be used to assess the parathyroid glands during pregnancy, although this test may not show deeper parathyroid glands.

Schedule Your PHPT Consultation With Dr. Larian 

The complexity and delicacy of treating primary hyperparathyroidism in pregnancy cannot be overstated. It is critical to work with a physician who has expertise in the parathyroid gland and performs parathyroidectomies daily to ensure the safest results. Dr. Larian at the Center for Advanced Parathyroid Surgery offers comprehensive diagnostics and treatment plans, with minimally invasive parathyroidectomies available. To schedule your consultation or learn more, contact our office online or call us today at 310-461-0300.

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