Patients with primary hyperparathyroidism

Hyperparathyroidism is the medical term used to describe the overproduction of parathyroid hormone (PTH) made by the parathyroid glands. This hormone is responsible for controlling the levels of calcium in our blood. This leaflet is intended to provide information for patients who have been diagnosed with this condition.

What do the parathyroid glands do?

The parathyroid glands are four small glands that lie behind the thyroid gland in the neck. However, they do not have any working connection with the thyroid gland. The parathyroid glands control the level of calcium in the blood by producing a hormone called Parathyroid Hormone (PTH).

It is important for calcium to be kept at the correct level. If the level of calcium falls then the parathyroid hormone is produced which raises the calcium levels so that when they are within the normal range. PTH raises the levels of calcium in the blood in three ways:

• by reducing calcium lost by the kidneys
• by increasing the absorption of calcium from the gut
• by causing the release of calcium from the bones

What is hyperparathyroidism?

This is the medical term used when the parathyroid gland or glands become overactive and an excess of PTH is released into the blood. This usually leads to high levels of calcium in the blood.

What causes hyperparathyroidism?

The most common cause of hyperparathyroidism is the development of a benign tumour called an adenoma in the gland. This is a non cancerous growth that makes too much PTH. Less commonly one or more of the glands may enlarge (a condition known as hyperplasia) and again produce too much PTH.

How is hyperparathyroidism diagnosed?

Hyperparathyroidism does not always cause symptoms and is often diagnosed on a routine blood sample. In primary hyperparathyroidism the calcium and PTH levels are persistently raised.

You may also have other investigations requested by your hospital doctor which may include urine tests, a bone scan (DXA scan) or scans of your neck.

What are the symptoms of hyperparathyroidism?

Most people with hyperparathyroidism feel well but some may have symptoms. If your calcium is too high you may feel tired, slightly nauseated, have constipation, low mood, joint bony pains and or feel thirsty. You may pass large amounts of urine frequently. Rare complications of hyperparathyroidism include the development of gastric ulcers, pancreatitis and kidney stones. If a patient’s symptoms are very subtle, they may only notice that they feel better after the problem has been treated.

What are the possible consequences of untreated hyperparathyroidism?

Untreated hyperparathyroidism can cause symptoms (detailed above) such as kidney stones, kidney disease or a reduction in bone mineral density (sometimes termed osteoporosis ). Rarely, patients can develop pancreatitis if the calcium level is quite high.

How is hyperparathyroidism treated?

You may not require any treatment. If you are not experiencing any symptoms, your calcium level is only slightly elevated and your bone and kidney health is close to normal then careful monitoring of your blood calcium levels and bone and kidney health may be all that is needed. However, if you are experiencing symptoms, have a particularly high calcium level, have kidney stones or have low bone mineral density treatment is usually recommended.

The most common treatment offered is surgery to remove the affected gland(s). If your doctor is considering surgery he/she will request tests to determine which parathyroid gland(s) is/are producing too much PTH. These tests will include an ultrasound scan of the neck and a nuclear medicine scan called a Sestamibi scan. This allows the doctor to identify which parathyroid gland to remove.

Removal of a parathyroid gland (para thyroidectomy) is performed by a consultant surgeon. The surgery does not usually take very long and can be curative. Your calcium level will be monitored after surgery to ensure it becomes normal . Very occasionally, the calcium level does not become normal after surgery possibly necessitating further surgery. For some people who have very high levels of calcium who are symptomatic and for whom surgery is not an option medication may be an option.