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Conditions

Hyperparathyroidism

What is hyperparathyroidism?

Hyperparathyroidism is a condition that results when the parathyroid glands produce excessive amounts of parathyroid hormone (PTH). Hyperparathyroidism may or may not produce symptoms. The condition is treated with supplements, medication, or surgery.

The four parathyroid glands are behind the thyroid gland, located at the front of the neck. They produce PTH, which regulates the amount of calcium, Vitamin D, and phosphorus in your body. Calcium is important for strong bones and also for healthy nerve conduction, heart function, blood pressure, and muscle movement. Phosphorus assists calcium with these functions. One of the roles of Vitamin D is to help replenish calcium levels in the body.

Hyperparathyroidism occurs when the parathyroid glands produce too much parathyroid hormone. As a result, too much calcium is in the blood and insufficient phosphorus.

  1. Women are at increased risk of hyperparathyroidism compared to men.
  2. Increasing age – more than 65 yrs.
  3. Vitamin D deficiency.
  4. Genetic predisposition – Familial hyperparathyroidism
  5. Multiple endocrine neoplasia type I is a rare inherited disorder that increases the risk of developing hyperparathyroidism.
  6. People with certain medical conditions, including rickets, kidney failure, malabsorption syndrome, parathyroid gland cancer, or enlarged parathyroid glands, have an increased risk of hyperparathyroidism.

There are three types of hyperparathyroidism:

Primary hyperparathyroidism

Primary hyperparathyroidism is caused by the enlargement of one or more parathyroid glands. Women are more likely than men to develop primary hyperparathyroidism, and the risk increases with age. Sometimes, radiation to the neck region (for example, radiation given as part of cancer treatment) can increase the risk of developing this condition as well. Taking low calcium for a long time may also increase the risk of developing primary hyperparathyroidism.

Secondary hyperparathyroidism

Secondary hyperparathyroidism is caused by conditions such as kidney failure, rickets (Vitamin D deficiency), or absorption problems in the intestines, which create low calcium levels.

Tertiary hyperparathyroidism

Tertiary hyperparathyroidism occurs when the parathyroid glands produce too much calcium after there is adequate calcium in the body. Tertiary hyperparathyroidism occurs most frequently in people with kidney failure.

Hyperparathyroidism may or may not cause symptoms and tends to develop gradually over time.

  • Nausea, vomiting, tiredness
  • Joint aches and back pain
  • Dizziness
  • Muscle weakness
  • Increased thirst
  • Increased urinary output
  • Progressive decline in kidney function.
  • Increased risk of kidney stones and thinning of bones, which may ultimately cause osteopenia/osteoporosis (decreased bone density), which may contribute to fractures.
  • Irritability, confusion, and memory impairment.

Dr Reena Thomas will help diagnose this condition with a comprehensive medical evaluation. She will order blood tests to evaluate the metabolic panel, including calcium, phosphorous, and parathyroid hormone levels. She will also do urine studies to detect the increased excess calcium loss. She will do an ultrasound of the neck in the office to localize the abnormal parathyroid gland. She will refer you to the nuclear medicine department for a special scan called the sestamibi scan. The sestamibi test uses a small amount of a radioactive substance to highlight abnormal areas of the parathyroid gland. You may also be referred for a 4-D CT scan of the neck – which is done if the parathyroid adenoma is not easily identified by an ultrasound or/and sestamibi scan.

Getting the appropriate tests is important to determine why you have this condition and guide the appropriate treatment.

The treatment for hyperparathyroidism depends on your age, severity, and type of hyperparathyroidism. Dr Reena Thomas will discuss the results of the blood tests, urine studies, and imaging studies and formulate an individualized treatment plan.

In mild primary hyperparathyroidism, you may just need regular monitoring of your blood calcium levels, kidney function, and bone density studies. In moderately severe or severe hyperparathyroidism, you will need surgery.

The different modalities of treatment of hyperparathyroidism are:

Lifestyle modifications

Dr Thomas will advise you on important lifestyle changes to manage hyperparathyroidism.

Surgery

She will refer you to an experienced surgeon for removal of the enlarged parathyroid gland.

Medications

When surgery fails to remove the enlarged parathyroid gland in primary hyperparathyroidism, or if you have any contraindications to surgery, then you will be initiated on oral medications that will help lower the blood calcium levels.

Long-term follow-up is required for monitoring your blood calcium levels at regular intervals. Dr Reena Thomas will perform a comprehensive evaluation, appropriate tests, and imaging needed to optimally monitor any recurrence of the tumor.

At a Glance

Dr. Reena Thomas, MD

  • Dual American board-certified endocrinologist
  • Author of numerous academic and clinic research
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