Primary Hyperparathyroidism

Primary hyperparathyroidism is a disease of high calcium.

Most people know that calcium is important for bone health. But calcium is also essential for your brain, nerves, muscles, heart, and blood. Your body depends on having the right amount of calcium in the blood, and doesn’t like calcium levels that are either too high or too low.

Calcium is so important that it has its own dedicated organ – the parathyroid. You have four parathyroid glands in your neck, mostly located around the thyroid. All four exist solely to regulate calcium levels, and they do this by making parathyroid hormone, or PTH. When your serum calcium level drops too low, your parathyroid glands make more PTH. This raises the calcium level in several ways. If the calcium rises too high, the parathyroid glands stop making PTH, which allows the calcium to drop back to normal.

When one or more parathyroid glands make more PTH than the body needs, this leads to high calcium levels. Usually this overactivity is due to a benign tumor in the parathyroid called a parathyroid adenoma. Although these tumors are generally very small, cannot be felt, and often cannot be seen on most imaging scans, they can do significant damage to your physical and mental health. Fortunately, most of them can be found and removed during a safe outpatient procedure. Unfortunately, the condition needs to be diagnosed before it can be treated, and health care providers are not always aware of how to diagnose this, leading to delays in treatment.

Important: A high calcium level in the blood is usually caused by parathyroid disease, often due to a benign parathyroid tumor. While these tumors are almost never cancerous, they still need to be removed.

Signs and Symptoms of Primary Hyperparathyroidism

Most people with primary hyperparathyroidism have symptoms or will develop them over time. The most common signs and symptoms are:

• Fatigue, or feeling more tired than usual
• General sense of being sick, "not feeling like myself"
• Difficulty sleeping through the night, insomnia
• Loss of interest in normal activities
• Difficulty concentrating
• Memory loss
• Body aches
• Increased urination
• Increased thirst
• Headaches
• Bone pain
• Hypertension, high blood pressure
• Heartburn, reflux
• Osteopenia or osteoporosis, thinning bones
• Bone fractures
• Kidney stones
• Palpitations, feeling like heart is fluttering
• Atrial fibrillation (cardiac arrhythmia)
• Chronic kidney disease, even leading to kidney failure and dialysis
• Hair loss in women

The most common symptoms of parathyroid disease are fatigue and a general sense of not being well. This can range from mild tiredness to severe fatigue that makes it difficult to work or perform normal daily activities. Cognitive symptoms like inability to concentrate and memory loss are also common. Because the most common symptoms are non-specific (they could be caused by many illnesses), people with primary hyperparathyroidism are often misdiagnosed. Women are often told that the symptoms are due to menopause, or premenopause. Men are told that these are just the signs of getting older. Many patients feel bad but have difficulty describing it; after surgery they report, "I feel like myself again."

Parathyroid Surgery

For primary hyperparathyroidism, the only cure is with an operation (parathyroidectomy). During the operation, one or more diseased parathyroid glands are removed.

There are no medications that can cure primary hyperparathyroidism. There are medications that can help bring your calcium levels down if they are extremely high, but this is a temporary measure and should be followed up with surgery when possible.

Read more on our Parathyroid Surgery page.

Primary vs. Secondary

Secondary hyperparathyroidism is another form of parathyroid disease. It's very important to distinguish primary from secondary, because the treatment is different. Most of the time, it is easy to tell them apart.

In secondary hyperparathyroidism, the parathyroids are overactive, but the problem did not start with the parathyroids. The underlying problem is usually chronically low calcium levels. Low calcium levels cause the parathyroids to release more PTH in an attempt to get the calcium up. If your body cannot get the calcium back up to normal, the parathyroid glands will just work harder - making more and more PTH! That is the job of parathyroids, after all. Over time, the PTH can get quite high, which leads to bone loss. The PTH causes bones to release calcium, again in an attempt to bring up the blood calcium levels.

The best way to tell primary from secondary hyperparathyroidism is to look at the calcium. In primary, the calcium level is almost always high. In secondary, the calcium is almost always low. You cannot have secondary hyperparathyroidism if your calcium is high. For help in interpreting your calcium levels or diagnosing parathyroid disease, go to the Parathyroid Disease Analysis page.

To treat secondary hyperparathyroidism, you need to know the underlying cause. The cause may be a severe Vitamin D deficiency, a history of gastric bypass or other intestinal surgery, chronic diarrhea, or renal failure. First-line treatment is aggressive supplementation with calcium and Vitamin D to get the calcium back into a normal range. If the calcium is normal, the parathyroid glands will be able to relax and stop making so much PTH. Surgical intervention is necessary in only some cases of secondary hyperparathyroidism, particularly if the glands have grown so much that they can no longer “turn off,” even when the calcium is back in normal range.