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- Hyperparathyroidism definition and facts*
- What is hyperparathyroidism?
- What are the parathyroid glands?
- What is a primary hyperparathyroidism?
- How common is hyperparathyroidism?
- Why are calcium and phosphorous so important?
- What causes hyperparathyroidism?
- What are the symptoms of hyperparathyroidism?
- How is hyperparathyroidism diagnosed?
- Will surgery cure hyperthyroidism?
- How is hyperparathyroidism treated?
- Which doctors specialize in treating hyperparathyroidism?
What are the symptoms of hyperparathyroidism?
A person with hyperparathyroidism may have severe symptoms, subtle ones, or none at all. Increasingly, routine blood tests that screen for a wide range of conditions, including high calcium levels, are alerting doctors to people who have mild forms of the disorder even though they are symptom-free.
- a loss of appetite,
- confusion or impaired thinking and memory, and
- increased thirst and urination.
Patients may have thinning of the bones without symptoms, but with risk of fractures.
Increased calcium and phosphorus excretion in the urine may cause kidney stones.
Is there a blood test to diagnose hyperparathyroidism?
Hyperparathyroidism is diagnosed when tests show that blood levels of calcium and parathyroid hormone are too high. Other diseases can cause high blood calcium levels, but only in hyperparathyroidism is the elevated calcium the result of too much parathyroid hormone. A blood test that accurately measures the amount of parathyroid hormone has simplified the diagnosis of hyperparathyroidism.
Once the diagnosis is established, other tests may be done to assess complications. Because high PTH levels can cause bones to weaken from calcium loss, a measurement of bone density can help assess bone loss and the risk of fractures. Abdominal images may reveal the presence of kidney stones and a 24-hour urine collection may provide information on kidney damage, the risk of stone formation, and the risk of familial hypocalciuric hypercalcemia.
Will surgery (parathyroidectomy) cure hyperthyroidism?
Surgery to remove the enlarged gland(s) (parathyroidectomy) is the main treatment for the disorder and cures it in 95 percent of operations, with low complication rates when performed by surgeons experienced with hyperparathyroidism.
What are the complications of parathyroidectomy surgery?
- About 1% of patients undergoing surgery experience damage to the nerves controlling the vocal cords, which can affect speech.
- One to 5% of patients lose all their parathyroid tissue and thus develop chronic low calcium levels, which may require treatment with calcium or vitamin D.
- The complication rate is slightly higher for hyperplasia than it is for adenoma since more extensive surgery is needed.
Are parathyroid imaging tests needed before surgery?
The NIH panels recommended against the use of expensive imaging tests to locate benign tumors before initial surgery. Such tests are not likely to improve the success rate of surgery, which is about 95 percent when performed by experienced surgeons. Simple imaging tests before surgery are preferred by some surgeons. Localization tests are useful in patients having a second operation for recurrent or persistent hyperparathyroidism.
What are other treatment options for hyperparathyroidism?
Medications to treat hyperparathyroidism
Calcimimetics are a new class of drug that turns off secretion of PTH. They have been approved by the Food and Drug Administration for the treatment of hyperparathyroidism secondary to kidney failure with dialysis, and primary hyperparathyroidism caused by parathyroid cancer. They have not been approved for primary hyperparathyroidism, but some physicians have begun prescribing calcimimetics for some patients with this condition. Patients can discuss this class of drug in more detail with their physicians.
Long-term monitoring hyperparathyroidism
Some patients who have mild disease may not need immediate treatment, according to panels convened by the National Institutes of Health (NIH) in 2002. Patients who are symptom-free, whose blood calcium is only slightly elevated, and whose kidneys and bones are normal may wish to talk with their physicians about long-term monitoring. In the 2002 recommendation, periodic monitoring would consist of clinical evaluation, measurement of serum calcium levels, and bone mass measurement. If the patient and physician choose long-term follow-up, the patient should try to drink lots of water, get plenty of exercise, and avoid certain diuretics, such as the thiazides. Immobilization (inability to move) and gastrointestinal illness with vomiting or diarrhea can cause calcium levels to rise. Patients with hyperparathyroidism should seek medical attention if they find themselves immobilized, vomiting, or having diarrhea.
Which doctors specialize in treating hyperparathyroidism?
Endocrinologists are doctors who specialize in hormonal problems. Nephrologists are doctors who specialize in kidney and mineral disorders. Along with surgeons who are experienced in endocrine surgery, endocrinologists and nephrologists are best qualified to treat people with hyperparathyroidism. Organizations that help people with hyperparathyroidism may have additional information to assist in finding a qualified health professional nearby.
Medically reviewed by James Felicetta, MD; American Board of Internal Medicine with subspecialty in Endocrinology, Diabetes & Metabolism
SOURCE: National Institutes of Health. "Primary Hyperparathyroidism." Updated: August 2012.