What is Hyperparathyroidism?
Primary Hyperparathyroidism occurs when TOO MUCH parathyroid hormone is released by the parathyroid glands in the neck. This , in turn, releases TOO MUCH calcium into the blood.
There are three types of Hyperparathyroidism - primary, secondary and tertiary.
In Primary Hyperparathyroidism (or PHPT) too much parathyroid hormone is produced by one or more of the parathyroid glands in your neck because they have become enlarged or overactive. This in turn releases too much calcium into the blood and causes high calcium levels (hypercalcaemia).
In Primary Hyperparathyroidism you may not have any symptoms at all despite high levels of calcium or you may just feel 'not quite right'. (Sometimes the condition is only discovered by chance in these cases while investigating something else.)
Alternatively, you may develop moderate symptoms (which doctors sometimes refer to as 'moans, groans, stones and bones') which indicate that your calcium levels are too high and require treatment. And sometimes your parathyroid hormone blood tests may come back as 'normal' but you remain very symptomatic.
Symptoms may also be severe and debilitating. As calcium is found in every cell in the body, high levels of calcium and parathyroid hormone can affect bone, kidneys, muscles, nerves and the gut as well as the emotions.
Early warning signs can include:
In extreme cases, and if left untreated, the symptoms become much worse and can include:
Hypercalcaemia can be a life threatening condition if it is not treated.
Long term complications
Complications may develop over time and can include:
The severity of your symptoms doesn’t always match up to the calcium level in your blood. People with a slightly high calcium level can have very severe symptoms, and people with a very high calcium level may only have mild symptoms.
When there are no symptoms, hypercalcaemia can be difficult to diagnose. Sometimes it may be discovered by chance or you may already have kidney stones or pancreatitis. Some people live unwittingly with hyperparathyroidism for many years before getting a diagnosis.
In a straightforward case, blood tests will show a high level of calcium, a high level of parathyroid hormone and usually, a low level of phosphate in your blood.
However, this isn't always an easy condition to diagnose. Sometimes your tests will be normal but you may still be symptomatic. This is much harder to diagnose and the UK 'watch and wait' policy can often lead to much distress.
You will need other tests to check how your kidneys are working, to measure the density of your bones and to look at the parathyroids themselves. Some tests can be done at your surgery but you may also be referred to hospital for further investigations by a specialist.
Further tests should include blood tests for vitamin D, kidney function, a kidney scan and a 24 hour urine test; a bone DEXA scan and x ray; a scan (and maybe a biopsy) of the parathyroid glands.
If you have hypercalcaemia, you will need treatment from your endocrinologist.
Your doctor may decide to monitor your levels for a while before taking further action. If you are unhappy about this, ask to see a specialist. You should, in any case, be given regular blood tests, a DEXA bone scan and a 24 hour urine test.
Self help - drinking more water, eating fewer calcium foods and taking more excercise may sometimes be enough action to bring your calcium levels down.
PLEASE NOTE: If you have hypoparathyroidism, but your calcium levels are unstable, they can sometimes go TOO HIGH as well as too low. You may have to spend a day or two in hospital having your levels monitored by blood tests. You may be given medication and a drip to help get your calcium levels down.
This is the most effetcive treatment available at present. If your hyperparathyroidism is severe or your bones become too thin, the offending parathyroid gland (s) can be removed by surgery. This operation is called a parathyroidectomy and usually brings about an instant cure. All abnormal glands need to be removed. If all four parathyroid glands are overactive, usually three-and-a-half of the glands are removed so that you have some remaining parathyroid tissue.