Hyperparathyroidism | Specialists and Information

Every person has four parathyroid glands. The main function of these glands is to regulate the levels of calcium and phosphate in the body using parathyroid hormone (PTH). Both calcium and phosphate are crucial for bone formation.

However, calcium also plays a very important role in nerve tissue and muscles. Day and night, the parathyroid glands measure the calcium levels in the blood. If these levels drop too low, parathyroid hormone causes more calcium to be released from bone stores.

In cases of overactive parathyroid glands (= hyperparathyroidism), too much parathyroid hormone is released even when the blood calcium level is normal. Calcium is released from the bones, leading to osteoporosis. Since this results in a persistently higher level of calcium in the blood than the body needs, more calcium is also excreted. This leads to the formation of kidney stones.

Schematic diagram of a bone and kidneys. Courtesy of Dr. Georg Wille, M.D.

In hyperparathyroidism, there is a benign proliferation of parathyroid cells, causing the parathyroid gland to enlarge (usually to a diameter of about 1 cm). These so-called parathyroid adenomas also produce too much parathyroid hormone, flooding the body with it. An adenoma produces far more than is needed (a small, uncontrolled hormone factory).

Parathyroid gland specimen. Courtesy of Dr. Georg Wille, M.D.

Very often (about 80%), such adenomas affect only one of the four parathyroid glands. According to statistics, in about 20% of cases, two or more glands are affected in patients. In extremely rare cases, a malignant tumor causes hyperparathyroidism.

As a result of the disrupted calcium-phosphate balance, hyperparathyroidism leads to changes in bone structure. The bones lose calcium and, as a result, also lose stability. Doctors refer to this “brittle bone” condition as osteoporosis.

Joint and bone pain are equally common. Pain in the musculoskeletal system caused by primary hyperparathyroidism is often misdiagnosed as nonspecific symptoms because no underlying disease is detected. Consequently, a provisional diagnosis of polymyalgia rheumatica is often made. The key to an accurate diagnosis would be measuring calcium and parathyroid hormone levels in the blood (in the same blood sample).

As the disease progresses, the disrupted calcium-phosphate balance also leads to an increased incidence of kidney stones. Calcium-phosphate deposits are frequently found in small blood vessels, particularly in the kidneys, which over time leads to impaired kidney function.

Typical symptoms include vague signs such as fatigue, decreased performance, and an increased tendency toward depressive moods. High blood pressure, constipation, and cardiac arrhythmias can also occur frequently.

Early detection of hyperparathyroidism is essential to prevent long-term damage or at least limit it. Unfortunately, the condition is often discovered only during routine blood tests. In these tests, only a slightly elevated calcium level is frequently found.

If your primary care physician tells you that your calcium level is a little too high, ask for a parathyroid hormone (PTH) test. If this level is also elevated, it clearly indicates hyperparathyroidism.

A scintigraphy and ultrasound examinations are suitable imaging methods for locating the overactive parathyroid gland.

In cases of primary hyperparathyroidism, the causative adenoma must be surgically removed during parathyroid surgery. This procedure is minimally invasive and is very well tolerated by patients. Since not all parathyroid glands are typically affected to the same extent, the remaining glands take over the important regulatory role in the body’s calcium balance.

If surgery is not possible, or as a temporary measure until the actual surgery date, the patient can be treated with medication, such as calcimimetics. Other medications lower the calcium level in the blood and ensure that more calcium is deposited in bone tissue.

Increased fluid intake or intravenous infusions can also help prevent kidney stones. In addition, patients should avoid calcium-rich foods.

Once the diseased parathyroid gland is surgically removed and circulating calcium levels can be normalized, the damage to the affected organs (bones, kidneys, heart) also stops.

Pain that has sometimes persisted for years very often disappears immediately after surgery. Patients often feel significantly more energetic, alert, and less exhausted after a few weeks.

The physicians who treat hyperparathyroidism are primarily endocrinologists (who can make an accurate diagnosis).

The surgery should be performed by a surgeon with proven expertise in thyroid and parathyroid surgery. A high volume of such surgeries increases expertise and reduces complications. This fact has been scientifically proven multiple times in recent years.