Hyperparathyroidism: Symptoms and Treatment

Medically Reviewed by Poonam Sachdev on February 22, 2024
Written by Marijke Vroomen Durning, RN, Sally Shepard, Amy Gopal
8 min read

You have two pairs of parathyroid glands, which are pea-sized, oval-shaped glands behind your thyroid. These four glands in your neck secrete a hormone, called parathyroid hormone, which helps regulate the amount of calcium in your blood. Sometimes, the parathyroid glands produce too much of this hormone. When this happens, it's called hyperparathyroidism.

The parathyroid hormone can raise your calcium level in three ways:

  • It can tell your bones to release some calcium.
  • It can tell your small intestine to absorb more calcium into your bloodstream.
  • It can tell your kidneys to retain more calcium instead of sending it out of your body through your pee.

There are three different kinds of hyperparathyroidism:

Primary hyperparathyroidism

This means that your condition is caused by, or starts in, at least one of the parathyroid glands naturally making too much of the hormone that keeps your calcium levels in balance.

Secondary hyperparathyroidism

This means that some other disease or condition is to blame. The common trigger is low calcium levels in the blood, which prompts your body to release parathyroid hormone almost immediately.

Tertiary hyperparathyroidism

This type of hyperparathyroidism occurs among some people who have had kidney transplants or untreated secondary hyperparathyroidism. In this case, the glands can’t stop producing parathyroid hormone, and calcium levels stay high. Even if you have a kidney transplant, your parathyroid glands may not go back to working normally.

About 100,000 people in the U.S. develop primary hyperparathyroidism each year. People aged 50-60 years and women are most likely to have hyperparathyroidism.

There are several possible causes for hyperparathyroidism.

Primary hyperparathyroidism causes

A noncancerous (benign) tumor called an adenoma in one of the parathyroid glands is the most common cause of primary hyperparathyroidism. Other causes include:

  • Two or more of the glands are too active, producing too much parathyroid hormone.
  • Cancer of one of the glands. This is a very rare cause of primary hyperparathyroidism.

Secondary hyperparathyroidism causes

Secondary hyperparathyroidism is most often caused by chronic kidney failure. Other causes include:

  • You have extremely low levels of vitamin D. This vitamin helps balance the amount of calcium in your blood, and it helps your digestive system absorb calcium. Causes might include:
  • Your body doesn’t get enough calcium. You could have low calcium levels in your blood for different reasons. You might be too low on vitamin D, or your digestive system might have problems absorbing calcium. It also often happens if you have chronic kidney disease.

Tertiary hyperparathyroidism causes

If secondary hyperparathyroidism goes untreated for too long, it can result in tertiary hyperparathyroidism. Even if you receive treatment and your calcium levels go back to normal, you may have ongoing problems with your parathyroid glands. It can happen to those with chronic kidney failure and kidney transplant recipients.

Hyperparathyroidism is often diagnosed through routine blood tests before you might show any symptoms. If calcium levels in your blood are high, then your doctor will want to find out the cause, as this could mean you have hyperparathyroidism.

If the disease hasn’t been picked up through blood tests, you could start to show symptoms such as:

  • Nausea and vomiting
  • Loss of appetite
  • Stomach pain
  • Feeling ill but not having any diagnosis for it
  • Fatigue
  • Bone and joint pain
  • Depression
  • Forgetfulness
  • Kidney stones

You may also have osteoporosis, which refers to thinning of the bones.

Secondary hyperparathyroidism symptoms

Unlike primary hyperparathyroidism, symptoms of secondary hyperparathyroidism are often related to what caused the disease. For example, if it's caused by kidney failure or kidney disease, you could experience broken bones due to osteomalacia (soft bones) or osteoporosis. If a child develops secondary hyperparathyroidism due to rickets (caused by low vitamin D), symptoms could include:

  • Slow or poor growth
  • Bowed (deformed) limbs
  • Weakness
  • Swollen joints
  • Broken bones
  • Bone pain
  • Slow or delayed tooth development

Your doctor will make the diagnosis based on blood tests.

If the results show that you have high levels of parathyroid hormone and calcium, then you have primary hyperparathyroidism. You’ll then get:

  • X-rays to check for broken bones in certain areas, including in your back
  • Bone density tests to look for reduced bone mineral density, especially in your forearm
  • Kidney ultrasound to look for kidney stones
  • 24-hour urine calcium collection to check for any kidney problems
  • Blood tests to see how well your kidneys work and your levels of phosphate and vitamin D. These tests can help determine if you have secondary hyperparathyroidism.

Anyone can develop either primary or secondary hyperparathyroidism, but some people, such as women (especially after menopause), are at higher risk. Others at risk include people who:

  • Have had radiation treatment to their neck to treat neck cancer
  • Are malnourished and have calcium and/or vitamin D deficiency
  • Use a drug called lithium to treat bipolar disorder
  • Have a rare genetic disorder, such as multiple endocrine neoplasia type 1
  • Are Black (for primary hyperparathyroidism)

If you have primary hyperparathyroidism along with bothersome symptoms, you’ll need surgery to remove the overactive parathyroid gland or glands. For example, if you have extremely high blood calcium levels, have had a broken bone (or fracture), or have kidney stones, your doctor will likely want you to have that operation.

Even if you don’t have symptoms, your doctor may recommend the operation.

You might get these benefits from the surgery:

  • Improved bone density
  • Fewer bone fractures
  • Less chance of forming kidney stones

Surgery cures primary hyperparathyroidism in 95% of cases. Choose a surgeon who has a lot of experience in parathyroid surgery. Like any operation, there can be complications, so talk with your doctor about the risks and benefits, what to expect during the recovery, and how long you’ll be in the hospital.

If you’re not a candidate for surgery, you might just need:

  • Routine exams by your doctor
  • Blood tests
  • Bone density tests

Watchful waiting

Not everyone with hyperparathyroidism needs treatment. This may be the case if:

  • Your kidneys are still working well.
  • You don’t have any kidney stones.
  • Your calcium levels aren't too high.
  • You don’t have osteoporosis.
  • You don’t have any other symptoms that require treatment.

This is called watchful waiting. By keeping an eye on your health, you and your doctor will be able to detect any changes that could mean you need treatment.

Medications

If you do need medications, your doctor may prescribe one or more of these:

  • Calcimimetics. A calcimimetic is a drug that tries to fool your parathyroid glands into slowing down the release of the parathyroid hormone. This is the only drug that directly addresses the parathyroid gland. Cinacalcet is one example of a calcimimetic.
  • Hormone replacement therapy (HRT). If you've gone through menopause, your doctor may recommend HRT to help your bones keep calcium, making them stronger.
  • Bisphosphonates. People who have osteoporosis may benefit from drugs called bisphosphonates. They help prevent and treat bone loss. Depending on the type of bisphosphonate, you may need to take one pill once a week or once a month, or go for an intravenous (IV) dose once or twice a year. Examples of bisphosphonates include alendronate (Fosomax), ibandronate (Boniva), and risedronate (Actonel), among others.

Secondary hyperparathyroidism treatment

If you have secondary hyperparathyroidism, your doctor may recommend supplements of vitamin D and calcium. Medications used to directly treat secondary hyperparathyroidism are calcimimetics, usually with vitamin D supplements. Your doctor might prescribe a phosphate binder such as calcium carbonate, to restore normal levels of calcium, phosphorus, and parathyroid hormone.

If medicine can’t manage your symptoms, you and your doctor may consider surgery to remove your parathyroid glands.

Most complications due to hyperparathyroidism arise from having too much calcium in your blood and too little in your bones. Complications from undetected or untreated hyperparathyroidism could include:

  • Kidney stones. Kidney stones made up of calcium are the most common type of kidney stones. They are usually quite painful to pass and they can block the urinary tract, causing infection.
  • Osteoporosis. This  thinning of the bones due to low calcium makes them brittle and easy to break.
  • Heart disease. Examples such as high blood pressure (hypertension) and coronary artery disease are common complications of primary hyperparathyroidism.

While it’s not common, if you are pregnant and have untreated hyperparathyroidism, your baby could be born with dangerously low levels of calcium. This is called neonatal hypoparathyroidism.

If you and your doctor decide you don’t need surgery, you can:

  • Track how much vitamin D and calcium you get through your diet. But don’t deliberately cut down on calcium. Talk to your doctor about whether you should take supplements, and if so, how much.
  • Drink lots of fluids, especially water. Enough water can help prevent kidney stones.
  • Exercise. Regular exercise, especially strength training, keeps your bones strong.
  • Stop smoking. Smoking means more bone loss.
  • Avoid medicines that raise your calcium levels. Talk to your doctor if you’re on such medications, in case you need a different prescription.

Most people who have hyperparathyroidism find out by accident, through routine blood tests that show they have high calcium levels. It could explain symptoms of nausea, no appetite, and bone and joint pain. Hyperparathyroidism is treatable, so if you suspect you may have it, speak with your doctor to see what type of treatment plan is best for you.

What is the typical symptom of hyperparathyroidism?

There is no one typical symptom of hyperparathyroidism. However, the most common ones include nausea, vomiting, fatigue, and joint and bone pain.

What foods trigger hyperparathyroidism?

There aren't foods that trigger hyperparathyroidism, but consider the following nutrition tips when you have the disease:

  • Calcium-rich foods that are helpful to eat include dark green leafy vegetables, beans, and nuts such as almonds
  • Use healthy cooking oils, such as olive oil
  • Limit carbonated beverages, because they have phosphates that take away calcium from your bones. Stay hydrated by drinking 6-8 glasses of water a day.
  • Try to limit refined foods (white breads, pasta, and sugars)
  • Reduce your intake of trans fatty acids. Examples include highly processed foods such as store-bought cakes, cookies, fried foods, and margarine.

What is the most effective way to treat hyperparathyroidism?

Only your doctor can tell you the most effective way to treat your case of hyperparathyroidism. You may need surgery to stop an overactive gland, but testing, monitoring, and medications could also help.

Why do I feel so bad with hyperparathyroidism?

Hyperparathyroidism can make you feel miserable because you can feel fatigued, nauseated, and in pain but without any obvious reason. If you have secondary hyperparathyroidism because of kidney disease, this can also make you feel lousy. Speak with your doctor about ways to improve your symptoms.