Hyperparathyroidism

Signs and Symptoms

Most patients with primary hyperparathyroidism do not have any symptoms. Doctors often diagnose the condition through routine blood tests that show high levels of calcium. When symptoms do occur, they are generally due to continuously high levels of calcium in the blood and loss of calcium from bones.

Symptoms may include:

• Bone pain
• Bone loss leading to osteoporosis
• Muscle weakness
• Abdominal pain
• Nausea and vomiting
• Constipation
• Loss of appetite
• Kidney stones
• Excessive thirst
• Need to urinate more often
• Anxiety
• Depression
• Memory loss
• Fatigue
• Irregular heartbeats
• High blood pressure
• Itching

What Causes It?

Hyperparathyroidism may develop as a result of several conditions, including:

• Benign tumors in the parathyroid glands.
• Parathyroid cancer (rare).
• Conditions that lower the level of calcium in the blood, like chronic kidney disease. In this case, the parathyroid gland produces more PTH to compensate and correct the blood calcium level.

Who's Most At Risk?

Risk factors for hyperparathyroidism include:

• Age. The condition is most common in people above 60 years of age, but it can also occur in younger adults. Hyperparathyroidism in childhood is very unusual.
• Female gender. Women are more often affected than men.
• Radiation to the head and neck.
• Inherited endocrine problems.
• Conditions that cause low levels of calcium or vitamin D in your body.
• Treatment with medications like bisphosphonates or certain diuretics.

What to Expect at Your Provider's Office

Hyperparathyroidism is diagnosed through blood tests that show high levels of calcium and PTH. In most cases, health care providers discover primary hyperparathyroidism from a routine blood test.

If primary hyperparathyroidism is suspected, the doctor will:

• Ask about your medical and family history.
• Ask if you have any symptoms.
• Perform a physical examination.

Your provider may also order the following tests:

• Urine test. To look for kidney problems.
• Bone density scan. To check bone health.
• Ultrasound, CT, or MRI. To see if the parathyroid glands are enlarged and check for tumors.

Treatment Options

Prevention

There is no known way to prevent primary hyperparathyroidism. However, people who are at risk should avoid dehydration. They should also make sure they're getting adequate vitamin D and calcium in the diet.

Treatment Plan

You may not need immediate treatment if:

• You do not show any symptoms of the condition
• You have only slight increase in calcium levels

You will be monitored for blood calcium levels and bone density to watch for any changes in their condition.

However, surgery and drug therapy may be needed for primary hyperparathyroidism. If hyperparathyroidism is caused by another condition, additional drug treatment may be needed for that condition.

Drug Therapies

Your provider may prescribe the following medicines:

• Calcimimetic medicines, such as cinacalcet, to decrease the PTH production
• Calcitonin by injection, to decrease calcium levels in blood
• Bisphosphonates, such as zoledronate and alendronate, to lower calcium levels
• Estrogen modulators, such as raloxifene, to increase bone density and decrease calcium levels in blood

Surgical and Other Procedures

Surgery is the main treatment for primary hyperparathyroidism. One or more glands may be removed. This procedure is called parathyroidectomy.

Complementary and Alternative Therapies

Hyperparathyroidism should never be treated by alternative medicine alone. Some complementary and alternative medicine (CAM) therapies may support conventional treatment. Keep all of your health care providers informed about any CAM therapies you are considering using.

Do not take supplements without your provider's supervision. Following these nutritional tips may help your general health:

• Avoid stimulants, alcohol, and tobacco.
• Drink 6 to 8 glasses or filtered water daily.
• Exercise moderately at least 30 minutes daily, 5 days a week.
• Eliminate potential food allergens, including, preservatives, and food additives.
• Eat calcium-rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
• Avoid refined foods, such as white breads, pastas, and sugar.
• Use healthy cooking oils, such as olive oil or coconut oil.
• Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, and donuts, French fries, onion rings, processed foods, and margarine.
• Limit carbonated beverages. They are high in phosphates, which can leach calcium from your bones.

You may address nutritional deficiencies with the following supplements, as indicated by your provider. Make sure all of your providers are aware of any nutritional or herbal supplements you are considering using and take only under a doctor's supervision as these may alter the calcium balance in your body:

• A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
• Calcium citrate. Your doctor may recommend you take calcium with a glass of orange juice -- some forms of calcium are better absorbed in an acidic environment. You can also add acid to your diet by squeezing lemon juice over leafy greens. 
• Vitamin D.  
• Ipriflavone is a synthetic flavonoid similar to the flavonoids found in soy. Laboratory studies showed that ipriflavone may inhibit bone resorption. Although this supplement is marketed for osteoporosis, clinical studies results are mixed. Ipriflavone can lower white blood cell counts and has the potential to interact with a variety of medications. Speak with your physician.

The following herbs are sometimes used to support bone health, though thorough scientific studies are lacking. Talk to your provider before taking any herbs if you have hyperparathyroidism.

• Chaste tree (Vitex agnus castus) standardized extract. Chaste tree extract may promote bone growth after fractures. There are no studies using this herb in people with hyperparathyroidism. Chaste tree extract has many possible drug interactions and can have hormone-like effects in the body. People with a history of hormone-related conditions, or those who take hormone medications, should be particularly cautious. Speak with your physician.
• Dandelion (Taraxacum officinale) leaf tincture or tea. Certain drugs can interact with Dandelion, including lithium and some antibiotics. Speak with your physician. People with Ragweed allergies may also have an allergic reaction to Dandelion.

Although no studies have examined the effectiveness of specific homeopathic therapies for hyperparathyroidism, homeopaths may consider the following remedies:

• Calcarea carbonica (calcium carbonate)
• Calcarea phosphorica (calcium phosphate)

Prognosis/Possible Complications

The outlook depends on the type of hyperparathyroidism. The prognosis is excellent for people who have:

• No symptoms of primary hyperparathyroidism
• Undergone surgery to remove parathyroid glands
• Undergone minimally invasive surgery

Possible complications of hyperparathyroidism include:

• High risk of bone fractures
• High blood pressure
• Kidney stones

Various cardiovascular conditions are also associated with hyperparathyroidism.

Following Up

If you have surgery, your doctor will check your blood calcium levels for several months to be sure that the levels remain stable.

If you do not have surgery, your calcium levels will need to be checked over a longer period of time. Your checkups will also include a careful assessment of your bones and kidneys.

Supporting Research

Bawa S. The significance of soy protein and soy bioactive compounds in the prophylaxis and treatment of osteoporosis. J Osteoporos. 2010;2010:891058. PMID: 20981338 www.ncbi.nlm.nih.gov/pubmed/20981338.

Bringhurst FR, Demay MB, Kronenberg HM. Hormones and disorders of mineral metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology. 13th ed. Philadelphia, PA: Elsevier; 2016:chap 28.

Darr DA, Sritharan N, Pellitteri PK, Sofferman RA, Randolph GW. Management of parathyroid disorders. In: Lesperance MM, Flint PW, eds. Cummings Pediatric Otolaryngology. Philadelphia, PA: Elsevier Saunders; 2015:chap 124.

Doyle DA. Hyperparathyroidism. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, eds. Nelson Textbook of Pediatrics. 20th ed. Philadelphia, PA: Elsevier; 2016:chap 573.

Eftekhari MH, Rostami ZH, Emami MJ, Tabatabaee HR. Effects of "vitex agnus castus" extract and magnesium supplementation, alone and in combination, on osteogenic and angiogenic factors and fracture healing in women with long bone fracture. J Res Med Sci. 2014;19(1):1-7. PMID: 24672557 www.ncbi.nlm.nih.gov/pubmed/24672557.

Liu Y, Liu JP, Xia Y. Chinese herbal medicines for treating osteoporosis. Cochrane Database Syst Rev. 2014;(3):CD005467. PMID: 24599707 www.ncbi.nlm.nih.gov/pubmed/24599707.

Walker MD, Silverberg SJ. Primary hyperparathyroidism. Nat Rev Endocrinol. 2018;14(2):115-125. PMID: 28885621 www.ncbi.nlm.nih.gov/pubmed/28885621.

Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlove-Wuttke D. Chaste tree (Vitex agnus-castus) -- pharmacology and clinical indications. Phytomedicine. 2003;10(4):348-357. PMID: 12809367 www.ncbi.nlm.nih.gov/pubmed/12809367.