Do you often feel weak and your bones ache? Or did your doctor look at a blood report and say, "Your calcium level is a little high"? Maybe the reason behind this is a condition that we don't talk about much, but is very important. Today, let's talk about this condition called hyperparathyroidism in a simple way that you can understand.
What is hyperparathyroidism?
Simply put, hyperparathyroidism is when one or more of your parathyroid glands become overactive and produce too much parathyroid hormone (PTH). This causes the calcium level in your blood to rise. We medically call this hypercalcemia .
Imagine, behind the thyroid gland in our neck, there are four small glands about the size of a grain of rice. These are called the parathyroid glands. Just like the ball that controls the water level in our water tank at home, the main job of these glands is to control the calcium and phosphate levels in our blood at the right levels.
This is how it works:
- When calcium levels in the blood drop, these glands produce the hormone PTH.
- This PTH hormone sends a signal to our bones to "release some calcium into the blood."
- It also tells the kidneys to "reduce the amount of calcium excreted in the urine and keep it inside the body."
- Then, the kidneys activate vitamin D and send it to our intestines . Then, the intestines absorb the calcium in the food we eat well.
This is a very balanced system. However, in hyperparathyroidism, the PTH hormone is produced in excess, causing bones to continuously release calcium, making them thin and brittle. Additionally, the extra calcium that accumulates in the blood can be deposited in the kidneys (which can form stones), blood vessels, heart, and other organs, causing various health problems.
What are the main types of this condition?
Hyperparathyroidism can be divided into three main types, which are classified according to how they occur.
| Type | Simply put... |
|---|---|
| Primary hyperparathyroidism | The problem in this case is with the parathyroid gland itself. A tumor (usually non-cancerous) in the gland or an enlargement of the gland causes the body to produce PTH hormone even when it doesn't need it. |
| Secondary hyperparathyroidism | It's not the glands' fault here. Another medical condition (often Chronic Kidney Disease) causes the body's calcium levels to drop. In response, the parathyroid glands start working overtime to compensate for the deficiency. |
| Tertiary hyperparathyroidism | This happens when the secondary condition has been untreated for a long time. The glands continue to work too hard, becoming enlarged and producing PTH hormone uncontrollably. |
What are the symptoms?
Most people with this condition do not have any symptoms . High blood calcium levels are often discovered incidentally during a blood test done for another reason. However, some people, especially when their calcium levels are very high, may experience the following symptoms:
- Bone and joint pain
- Muscle weakness
- Constant tiredness and fatigue
- Depression
- Difficulty concentrating on one thing
- Appetite
- Nausea and vomiting
- Confusion, forgetting things
- Feeling extremely thirsty and needing to urinate frequently
- Constipation
Remember, these symptoms are very common. Not everyone who has them has hyperparathyroidism. But if these symptoms persist, it's best to see a doctor.
What causes this?
Let's look at the reasons for the three types we discussed earlier separately.
Causes of Primary Hyperparathyroidism
- Adenoma: This is a noncancerous tumor that forms in a parathyroid gland. This is the most common cause of primary hyperparathyroidism.
- Hyperplasia: This is when one of the parathyroid glands becomes larger.
- Cancer: Cancer of the parathyroid glands is a very rare cause.
Causes of Secondary Hyperparathyroidism
The main cause of this is Chronic Kidney Disease (CKD) . When the kidneys are not working properly, the phosphate levels in the body increase and the vitamin D levels decrease. This causes the calcium levels in the blood to decrease. So, to compensate for this calcium deficiency, the parathyroid glands produce too much PTH hormone.
Additionally, severe vitamin D deficiency (due to lack of sun exposure or nutritional deficiencies) can also cause this.
How to recognize this condition?
Your doctor will listen to your symptoms, examine you, and refer you for certain tests if they suspect this condition.
| Test | What are you looking at? |
|---|---|
| Blood Tests | Blood levels of calcium, PTH hormone, vitamin D, phosphate, and kidney function (Creatinine) are checked. |
| 24-hour Urine Test | The amount of calcium in urine collected over 24 hours is measured. |
| Parathyroid Scan | This can help pinpoint which gland is overactive. This is very important before surgery. |
| Ultrasound Scan | It is used to check the condition of the glands and kidneys in the neck. |
| Bone Density Scan | This test is done to see if the bones have lost calcium and become thin (Osteoporosis). |
How is it treated?
Treatment methods depend on whether you have primary or secondary type and the severity of the disease.
Treatment for primary hyperparathyroidism
The best and most permanent solution to this is to perform a surgery (parathyroidectomy) to remove the overactive gland or glands. After this surgery, more than 90% of people return to normal blood calcium levels.
If you are under 50, have symptoms, have very high calcium levels, have kidney stones, or have thin bones, your doctor will definitely recommend surgery.
In cases that are not serious and do not require surgery, your doctor will monitor your condition regularly. And sometimes:
- Bisphosphonates: These drugs prevent the release of calcium from the bones and strengthen them.
- Calcimimetics: These drugs "trick" the parathyroid glands into reducing the production of the hormone PTH.
- Lifestyle changes: You may be advised to stop taking certain medications (e.g., thiazide diuretics, lithium) and make dietary changes.
Treatment for secondary hyperparathyroidism
The key here is to treat the underlying cause , such as controlling kidney disease and treating vitamin D deficiency.
- A person with kidney disease may need dialysis or a kidney transplant.
- Medications such as phosphate binders are given to reduce phosphate levels in the blood.
- Vitamin D and calcimimetic drugs are also used for this purpose.
If these treatments cannot control the condition, surgery may be necessary.
The most important thing is, don't just take vitamin D or calcium pills on your own. Always consult your doctor and use them only as prescribed. Sometimes these can make things worse.
Take-Home Message
- Hyperparathyroidism is a condition in which calcium levels in the blood increase due to excessive production of the hormone PTH by the parathyroid glands.
- Most of the time, there are no specific symptoms. You may experience general symptoms like fatigue and bone pain.
- The primary type is caused by a problem in the gland itself, while the main cause of the secondary type is chronic kidney disease.
- The disease is diagnosed through blood, urine tests, and scans.
- The best treatment for the primary type is surgical removal of the affected gland.
- Always consult your doctor before using any medication or vitamin.
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