Hyperparathyroidism
Also listed as: Parathyroid - overactive
Hyperparathyroidism is a condition in which the parathyroid glands, located in the neck, secrete too much parathyroid hormone (PTH). Parathyroid hormone regulates the amount of calcium and phosphorus (minerals necessary for strong bones and teeth) in the body, by controlling how much calcium is taken from bones, absorbed in the intestines, and lost in urine. When too much parathyroid hormone is secreted, levels of calcium in the blood and urine rise, and bones may lose calcium, leading to osteoporosis.
Signs and Symptoms
In about half the cases of primary hyperparathyroidism, the person has either vague symptoms or no symptoms at all. The condition is often diagnosed through routine blood tests that show high levels of calcium. When symptoms do occur, they are generally due to persistently high levels of calcium and may include:
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Joint pain
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Bone loss leading to osteoporosis
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Muscle weakness
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Abdominal discomfort
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Nausea and vomiting
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Constipation
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Lack of appetite
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Kidney stones
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Excessive thirst
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Excessive urination
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Anxiety
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Memory loss
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Fatigue
What Causes It?
In most cases, the cause of hyperparathyroidism is not known. It may develop as a result of one of the following conditions:
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Benign tumors in the parathyroid glands
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Parathyroid hyperplasia (excessive growth of normal parathyroid cells)
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Parathyroid cancer (rare)
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Certain endocrine disorders, such as Type I and II multiple endocrine neoplasia (MEN) syndromes (rare)
Who's Most At Risk?
The following conditions or characteristics put you at higher risk for developing primary hyperparathyroidism:
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Age: risk increases as you get older (but the disease can also affect children).
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Gender: twice as many women as men have the condition.
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Inherited endocrine problems (MEN syndromes)
What to Expect at Your Provider's Office
Hyperparathyroidism is diagnosed through blood tests that show high levels of calcium and parathyroid hormone. About half the time, health care providers discover primary hyperparathyroidism from a routine blood test. If your doctor suspects primary hyperparathyroidism, the doctor will do a physical examination and ask about symptoms of abdominal pain and constipation, depression, anxiety, memory loss, muscle weakness, and urinary problems. The health care provider may order a urine test to check for kidney problems caused by excess calcium, and do a bone density scan to check bone health. An ultrasound of the neck may be performed to see if the parathyroid glands are enlarged. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used to check for a tumor.
Treatment Options
Prevention
There is no known way to prevent primary hyperparathyroidism. However, people who are at risk should avoid dehydration.
Treatment Plan
Surgery to remove one or more of the parathyroid glands is very successful in treating primary hyperparathyroidism. Sometimes, if a person does not show any signs or symptoms of the disease and has only mildly elevated calcium levels, they may not need immediate treatment -- but they will need to be monitored (for calcium blood levels and bone density) to watch for any changes in their condition.
Drug Therapies
Surgery is the primary treatment. However, under certain circumstances, the following medications may be used:
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A specific type of diuretic, along with intravenous fluids, can be used to lower levels of calcium in the blood while the person is awaiting surgery.
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Calcitonin may be given by injection to build bone density.
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Bisphosphonates, such as tiludronate and alendronate, may be used after surgery to lower calcium levels. However, they are not generally used long term.
Surgical and Other Procedures
Parathyroidectomy involves removal of one or more of the four parathyroid glands.
Complementary and Alternative Therapies
Hyperparathyroidism should never be treated by alternative medicine alone. Some CAM therapies may be supportive when used along with conventional treatment. Keep all of your health care providers informed about any CAM therapies you are considering using.
Nutrition and Supplements
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Ipriflavone is a variation of a soy isoflavone, or compound from plants, that has estrogen-like effects. It may help reduce bone loss and help prevent osteoporosis, and it does not appear to carry the same risk that estrogen does of breast or uterine cancer. Because hyperparathyroidism may lead to osteoporosis, taking ipriflavone may help treat this cause of bone loss. One study of people with hyperparathyroidism showed good results, but only had nine people. More research is needed to establish the value of using ipriflavone in people with hyperparathyroidism.
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Essential fatty acids -- Supplements containing GLA (gamma linolenic acid, found in evening primrose oil and borage seed oil) and EPA (eicosapentaenoic acid, found in fish oil) may help prevent bone loss, though more studies are needed to confirm their effect.
The following vitamins and minerals are also involved in bone formation. Check with your health care provider to see if you need to take supplements:
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Vitamin C
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Vitamin K
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Manganese
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Boron
Herbs
No scientific research has studied the use of herbs to treat hyperparathyroidism. The following herbs are sometimes used to counter the bone loss that can occur from hyperparathyroidism. You should consult your health care practitioner before taking any herbs if you have hyperparathyroidism, to see if these herbs are right for you and to determine the proper dose.
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Ginkgo biloba
extract contains substances similar to isoflavone in soy (see
Nutrition
section), so it may provide some degree of bone protection. But no studies have been done to test this theory.
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Horsetail (
Equisetum arvense
) and oat straw (
Avena sativa)
is rich in minerals and has been used traditionally to support bone health.
Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of hyperparathyroidism based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
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Calcarea carbonica
(calcium carbonate)
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Calcarea phosphorica
(calcium phosphate)
Prognosis/Possible Complications
The prognosis is excellent for persons with primary hyperparathyroidism who have no symptoms, as well as those who have surgery to remove one or more parathyroid glands. Possible complications include skeletal damage, urinary tract infections, kidney damage or kidney stones, peptic ulcers, inflammation of the pancreas, high blood pressure, nervous system disorders, and rare complications from surgery.
Following Up
If you have surgery, your doctor will check your blood calcium levels for several months to be sure that the levels remain stable. If you do not have surgery, your calcium levels will need to be checked over a longer period of time, and your checkups will include a careful assessment of your bones and kidneys.
Supporting Research
Abdelhadi M, Nordenstrom J. Bone mineral recovery after parathyroidectomy in patients with primary and renal hyperparathyroidism.
J Clin Endocrinol Metab
. 1998;83(11):3845-3851.
Barsotti G, Morelli E, Cupisti A, Meola M, Dani L, Giovannetti S. A low-nitrogen low-phosphorus vegan diet for patients with chronic renal failure.
Nephron
. 1996;74(2):390-394.
Beers MH, Porter RS, et al.
The Merck Manual of Diagnosis and Therapy.
18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1254-1255, 1256, 1258-1259.
Blumenthal M, ed.
The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines
. Boston, Mass: Integrative Medicine Communications; 1998.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds.
Harrison's Principles of Internal Medicine
. 14th ed. New York, NY: McGraw-Hill; 1998.
Head KA. Ipriflavone: an important bone-building isoflavone.
Altern Med Rev
. 1999;4(1):10-22.
Jorde R, Szumlas K, Haug E, Sundsfjord J. The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake.
Eur J Nutr
. 2002 Dec;41(6):258-63.
Mazzuoli G, Romagnoli E, Carnevale V, et al. Effects of ipriflavone on bone remodeling in primary hyperparathyroidism.
Bone Miner.
1992;19:(suppl 1):S27-S33.
NIH Osteoporosis and Related Bone Diseases National Resource Center.
Information for Patients about Primary Hyperparathyroidism.
National Institutes of Health. Accessed on October 30, 2000.
Silverberg SJ, Locker FG, Bilezikian JP. Vertebral osteopenia: a new indication for surgery in primary hyperparathyroidism.
J Clin Endocrinol Metab
. 1996;81(11):4007-4012.
Sosa JA, Powe NR, Levine MA, Udelsman R, Zeiger MA. Profile of a clinical practice: Thresholds for surgery and surgical outcomes for patients with primary hyperparathyroidism: a national survey of endocrine surgeons.
J Clin Endocrinol Metab
. 1998;83(8):2658-2665.
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Review Date:
12/11/2006
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Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
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