Parathyroid Problems: Hypoparathyroidism and Hyperparathyroidism

Patient Expert
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You have four pea-sized parathyroid glands located on your thyroid gland in your neck. Like other glands in the endocrine system, your parathyroid glands produce a hormone, in this case, parathyroid hormone, known as PTH. But, despite having a similar name, your parathyroid glands — parathyroid means “near the thyroid” — have a very different function from your thyroid. The PTH they produce helps regulate your body’s balance of calcium and phosphorous.

When calcium levels are too low, the parathyroid glands produce PTH, which facilitates the production and improved absorption of calcium. When calcium levels are too high, production drops, and this drop acts as a regulator to reduce calcium levels.

There are two main parathyroid problems – hyperparathyroidism and hypoparathyroidism – that can affect your health.

Hyperparathyroidism: Causes, symptoms, diagnosis, and treatment

When your parathyroid glands make too much PTH, your blood calcium levels increase (hypercalcemia), causing a condition known as hyperparathyroidism. Women are twice as likely as men to develop hyperparathyroidism. The risk in both genders increases with age.

Causes: There are several causes of hyperparathyroidism, including:

  • Most commonly, a non-cancerous tumor (adenoma) on your parathyroid gland causes overactive parathyroid glands.
  • Your parathyroid glands become enlarged (hyperplasia) and overproduce PTH.
  • Chronic kidney disease triggers overproduction of PTH.
  • Chronic vitamin D deficiency, due to inadequate nutrition or bowel disease, causes overproduction of PTH.
  • Radiation treatment of the head or neck

The least-common cause of hyperparathyroidism in a rare cancer of the parathyroid glands.

Symptoms: The symptoms of hyperparathyroidism are often mild, and can include:

  • Fatigue
  • Feeling thirsty
  • Frequent urination
  • Loss of appetite
  • Stomach upset and pain
  • Muscle weakness
  • Constipation
  • Cognitive changes, including difficulty concentrating, slight confusion
  • Mood changes, including anxiety and depression

More-severe hyperparathyroidism can cause symptoms that include:

  • Vomiting
  • Severe drowsiness
  • Dehydration
  • Confusion
  • Spasms in the muscles
  • Bone pain
  • An irregular heartbeat
  • Elevated blood pressure
  • Loss of consciousness

Less commonly, severe, long-standing, or untreated hyperparathyroidism can cause:

  • Osteoporosis and bone fractures
  • Kidney stones and kidney blockages
  • Kidney damage or kidney failure
  • Peptic ulcers
  • Pancreatitis

Diagnosis: Hyperparathyroidism is diagnosed with a blood test, looking for:

  • Elevated levels of PTH
  • Elevated levels of blood calcium
  • Low levels of phosphorus

According to the National Institute of Diabetes and Digestive and Kidney Diseases, bone mineral density tests — also known as DEXA scans — may also be used to evaluate the impact of PTH elevation on bone density.

Treatment: The treatment of hyperparathyroidism depends on the severity of the condition. Your doctor may recommend monitoring of mild hyperparathyroidism. More-severe or symptomatic hyperparathyroidism is usually treated with surgery to remove the benign tumor and any overproducing parathyroid glands. The cure rate for surgical treatment of hyperparathyroidism is more than 95 percent, with a very low complication rate.

Parathyroid surgery — known as parathyroidectomy — is performed to remove one or more of the parathyroid glands. Traditional parathyroid surgery has been performed with a large, four-inch or longer neck incision during a five-hour or longer inpatient surgery. Keep in mind, however, that a fast, outpatient surgery called minimally invasive parathyroid surgery — also known as "mini-parathyroid surgery" — is also available from some trained surgeons. This cutting-edge surgery is performed endoscopically, with much smaller incisions, takes less than an hour, and has a quicker recovery time than traditional parathyroid surgery.

In some cases, your doctor may prescribe medications called bisphosphonates — drugs such as alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel)  — to improve your bone density. You may also be prescribed the calcimimetics drug cinacalcet (Sensipar) to reduce your calcium and PTH levels and raise phosphate levels.

Your doctor will also likely advise you to drink plenty of water, get enough exercise, and avoid diuretic medications.

Hypoparathyroidism: Causes, symptoms, diagnosis, and treatment

When your parathyroid glands don’t produce enough PTH, blood calcium levels decrease (hypocalcemia) — and phosphorous levels increase — you have a condition known as hypoparathyroidism. Hypoparathyroidism is less common than hyperparathyroidism.

Causes: The most common causes of hypoparathyroidism include:

  • Damage or injury to your parathyroid glands, most commonly due to neck or thyroid surgery, but also the result of radiation to the neck as a cancer treatment
  • An autoimmune endocrine disease that attacks or destroys your parathyroid glands
  • Genetic conditions and congenital defects that impair your parathyroid glands’ ability to produce PTH
  • Surgical removal of your parathyroid glands

In some cases, your parathyroid glands are nicked or mildly damaged during surgery, causing temporary hypoparathyroidism that requires treatment but resolves over time.

If parathyroid problems have not yet been diagnosed, experts also recommend that hypoparathyroidism is ruled out if you have osteopenia or osteoporosis, kidney stones, bone breakage that isn’t the result of trauma, or diabetes. These conditions can all be triggered by longer-term, untreated hypoparathyroidism.

Symptoms: The symptoms of hypoparathyroidism include:

  • Tingling around your lips and mouth, known as paresthesia
  • Tingling in your fingers and toes
  • Painful cramping in your hands (tetany) and other muscles
  • Unusual muscle twitching, spasms, or jerking
  • Exhaustion
  • Mood changes, including irritability, anxiety, or depression
  • Cataracts
  • Dry, coarse, thickened skin
  • Coarse hair, hair that easily breaks
  • Hair loss
  • Weak fingernails that break easily
  • Horizontal ridges on your fingernails

Diagnosis: Hypoparathyroidism is diagnosed with blood tests, looking for:

  • Low blood calcium levels
  • High blood phosphorus levels
  • Low blood PTH levels

Some practitioners also test for creatinine, magnesium, and 25-hydroxy vitamin D levels. In some cases, urinalysis may also be performed, looking for high levels of calcium in your urine — a sign that you are excreting too much calcium.

Treatment: Treatment for hypoparathyroidism focuses on raising your calcium to normal levels. This is accomplished through oral calcium carbonate supplements, along with a vitamin D analog, usually calcitriol (Rocaltrol), which helps enhance your absorption of calcium. In rare cases, if calcium levels are dangerously low, short-term intravenous calcium and calcitriol treatment is used.

Promising investigational treatments are also being evaluated for hyperparathyroidism. Injections or pump infusion of various forms of synthetic PTH have been shown to be effective treatments for congenital hypoparathyroidism and may also apply to other forms of the condition.

Except in cases of temporary hypoparathyroidism after surgery, treatment is for life. You will also need regular blood tests to monitor your calcium levels.

Some experts also recommend a diet high in calcium — dairy and leafy green vegetables — and low in high-phosphorous foods like red meat, poultry, bread, and rice.

Who should treat your parathyroid problem?

In most cases, if you suspect a parathyroid problem, you should consult with an endocrinologist. These specialists have expertise in diseases and conditions that affect your parathyroid gland and they are most likely to be informed regarding the latest treatment approaches.

See more helpful articles:

Primary Hyperparathyroidism

Understanding Autoimmune Disease

When Do You Need an Endocrinologist?