Dr. M.J. Bazos, Patient Handout

About Your Diagnosis
Hyperparathyroidism simply means overactivity of the parathyroid glands. These four tiny glands are normally located in the neck next to the thyroid gland. Occasionally they may be found in the chest or within the thyroid itself. Wherever they are located, the parathyroids control normal calcium balance in the body. If blood calcium levels fall too low, the parathyroid secretes a hormone into the bloodstream to restore normal calcium levels. This hormone is aptly named parathyroid hormone (PTH). Parathyroid hormone works by increasing calcium absorption from the gut and bone, and by decreasing calcium excretion from the kidneys. Individuals with hyperparathyroidism have a disruption in the finely tuned mechanism of calcium balance, with increased blood calcium levels. The large majority of individuals with hyperparathyroidism (85%) have a benign tumor (adenoma) of one of their parathyroid glands. Most others have an enlargement of two or more glands (hyperplasia). Rarely, hyperparathyroidism may be caused by cancer of the parathyroid gland. Hyperparathyroidism is diagnosed in 100,000 individuals per year, and there is a female-to-male ratio of 2:1. There is increased risk with increasing age. Five percent of patients have familial disorders associated with other endocrine conditions. Hyperparathyroidism is diagnosed by simultaneously elevated blood calcium levels and PTH levels. Surgery will cure 95% of individuals.

Living With Your Diagnosis
Patients may have no signs or symptoms of their disease. It often is discovered incidentally on routine blood tests. Some patients may feel weak, fatigued, and depressed, or complain of muscle aches and joint pains. They may have a decreased appetite, nausea, vomiting, constipation, confusion, or frequent urination and thirst. Hyperparathyroidism left untreated can lead to osteoporosis, kidney stones, high blood pressure, inflammation of the pancreas, or stomach ulcers.

The best treatment for hyperparathyroidism is surgical removal of the tumor. This is only necessary for individuals with high calcium levels, bothersome symptoms, or when cancer is suspected. Many individuals may simply be monitored closely by their doctor. In an emergency, intravenous fluids, diuretics, and bisphosphonates may be given to abruptly lower dangerously high calcium levels. Complications of surgery include bleeding and infection. A low calcium level occurs, which may be temporary or permanent. Many surgeons recommend patients take calcium and vitamin D supplements postoperatively until the first outpatient visit to prevent a low calcium. Voice changes may be temporary when caused by anesthesia or permanent when caused by nerve damage at surgery.

The DOs
• Tell your doctor if you have a family history of parathyroid or other endocrine tumors.
• Provide old records for your doctor so he can determine when your blood calcium first became elevated.
• Drink plenty of water to prevent high blood calcium levels.
• Find an experienced surgeon to perform the operation. The likelihood of the success of surgery depends greatly upon the experience and skill of the surgeon.
• See your doctor regularly if no surgery is planned. It is recommended that blood work, urine, bone density testing, and kidney function testing should be performed on a regular basis for those who elect not to have surgery.

The DON’Ts
• Don’t allow yourself to become dehydrated.
• Don’t take calcium supplements unless approved by your doctor. This can lead to kidney stone formation and high calcium levels in the blood.

When to Call Your Doctor
• You become dehydrated or immobilized because of trauma or illness.
• You have symptoms suggestive of a kidney stone, including severe pain on your side or back and blood in your urine.
• You notice muscle spasms, face twitching, or numbness around the lips after your operation. These are symptoms of an underactive parathyroid gland and require immediate attention.

The National Institutes of Diabetes and Digestive and Kidney Diseases