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Hyperparathyroidism (excess parathyroid hormone)

Hohenga rawaka o te taha repe tenga

Illustration showing the larynx (voice box), trachea (windpipe) and thyroid gland, with four parathyroid glands behind the thyroidHyperparathyroidism happens when your parathyroid glands make too much parathyroid hormone.

You have four parathyroid glands. Each one is about the size of a grain of rice. The glands are in your neck, just behind your thyroid. The parathyroid hormone they make controls the amount of calcium and phosphate in your body.

When you have too much parathyroid hormone, you get too much calcium in your blood (hypercalcaemia).

The most common cause of hyperparathyroidism is a benign (not cancer) tumour in one of your parathyroid glands, called an adenoma. Another cause is if your parathyroid glands become enlarged and overactive. This is called hyperplasia. Very rarely, the cause is a cancer of the parathyroid gland.

Excess parathyroid hormone affects women more than men and usually starts after menopause. It's very rare in younger people.

Symptoms of hyperparathyroidism

Most people have no symptoms. The condition is usually picked up from a high blood calcium test that has been done for another reason.

In mild hyperparathyroidism, you can get joint aches, fatigue, weakness, loss of appetite, tummy pain and mild depression.

If your blood calcium is very raised, you can get constipation, marked loss of appetite with nausea and confusion. You may also feel very thirsty and pass a lot of urine.

Hyperparathyroidism can also cause kidney stones, impaired kidney function, osteoporosis and joint problems.

Diagnosing hyperparathyroidism

A blood test will show high calcium and usually low phosphate. It will also pick up high levels of parathyroid hormone. You may also need a urine test to collect all the urine you pass in 24 hours and see how much calcium is passed in your urine. This can help determine if you need treatment.

You may need a scan of your parathyroid glands.

You may also need to have a bone density scan to check the thickness of your bones. If your doctor thinks you might have kidney stones, you may also need a kidney scan.

Treating hyperparathyroidism

Your treatment will depend on how high your calcium levels are and how bad your symptoms are.

If your calcium is just slightly higher than normal and you do not have any symptoms, you will not need any treatment. You'll need a blood test every six to 12 months to check that your calcium levels aren't rising.

If needed, hyperparathyroidism is treated with surgery to remove the parathyroid gland or glands causing the problem.

The surgery is usually straightforward, but you'll need to stay in hospital for a couple of days.

Occasionally, surgery can damage your other parathyroid glands and you can get low calcium levels. You'll have regular blood tests after surgery to check this. You might also get a hoarse voice following surgery, which may be temporary or permanent. Very occasionally, the surgery will not work, and your symptoms will return.

A medication called cinacalcet can sometimes be taken instead of having surgery, but this is usually only prescribed if surgery is not possible. For example, if you have other health conditions that would make the risk of surgery too high. Cinacalcet works on the parathyroid glands to reduce the amount of parathyroid hormone they make.

Self‑care for hyperparathyroidism

If you have primary hyperparathyroidism and aren't being treated, or if the surgery has not fully solved the problem, you can do several things to look after yourself.

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Written by HealthInfo clinical advisers. Last reviewed June 2023.

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Page reference: 70636

Review key: HIPHP-70636