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 of the cases of primary hyperparathyroidism, the patient has either vague symptoms or no symptoms at all. Doctors often diagnose the condition 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:
- Joint pain
- Bone loss leading to osteoporosis
- Muscle weakness
- Abdominal discomfort
- Nausea and vomiting
- Lack of appetite
- Kidney stones
- Excessive thirst
- Excessive urination
- Memory loss
- Irregular heartbeats or other heart conditions
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:
- Benign tumors in the parathyroid glands
- Parathyroid hyperplasia (excessive growth of normal parathyroid cells)
- Parathyroid cancer (rare)
- 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:
- Age: risk increases as you get older, reaching a peak between 50 - 60 years (but the disease can also affect children).
- Gender: most cases occur in women (74%).
- Inherited endocrine problems (MEN syndromes)
- Previous neck irradiation
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 take a sample of your urine to test for kidney problems caused by excess calcium, and have you take a bone density scan to check bone health. Your doctor may order a neck ultrasound to see if the parathyroid glands are enlarged. You may also undergo a computed tomography (CT) scan or magnetic resonance imaging (MRI) to check for a tumor.
There is no known way to prevent primary hyperparathyroidism. However, people who are at risk should avoid dehydration. They should also ensure they're getting adequate vitamin D.
Surgery to remove one or more of the parathyroid glands is very successful in treating primary hyperparathyroidism. 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).
Surgery is the primary treatment. However, under certain circumstances, your health care provider may prescribe the following medications:
- A specific type of diuretic, along with intravenous fluids, to lower levels of calcium in the blood while the person is awaiting surgery
- Calcitonin by injection to build bone density
- Bisphosphonates, such as tiludronate and alendronate, after surgery to lower calcium levels
- Estrogens, such as Raloxifene, to increase bone density
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 complementary and alternative medicine (CAM) therapies may support conventional treatment. Keep all of your health care providers informed about any CAM therapies you are considering using.Nutrition and Supplements
Do not take supplements without your health care provider's supervision. Following these nutritional tips may help reduce symptoms of hyperparathyroidism:
- Eliminate all potential food allergens, including dairy, wheat (gluten), soy, corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
- Eat calcium-rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
- Avoid refined foods, such as white breads, pastas, and sugar.
- Use healthy cooking oils, such as olive oil or coconut oil.
- Reduce or eliminate trans-fatty acids, found in commercially-baked goods, such as cookies, crackers, cakes, and donuts. They are also found in French fries, onion rings, processed foods, and margarine.
- Limit carbonated beverages. They are high in phosphates, which can leach calcium from your bones.
- Avoid coffee and other stimulants, alcohol, and tobacco.
- Drink 6 to 8 glasses of filtered water daily.
- Exercise moderately at least 30 minutes daily, 5 days a week.
You may address nutritional deficiencies with the following supplements:
- A daily multivitamin, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc, and selenium.
- Calcium citrate, 500 to 1,000 mg daily, for bone support.
- Vitamin D, 1,000 to 3,000 IU daily, for immunity.
- Ipriflavone (soy isoflavones) standardized extract, 200 mg, 3 times a day, for bone loss. Because hyperparathyroidism may lead to osteoporosis, taking ipriflavone may help treat this cause of bone loss. Ipriflavone can lower white blood cell counts and has the potential to interact with a variety of medications. Speak with your physician.
Foods rich in calcium, which include:
- Dark leafy greens
- Blackstrap molasses
Your doctor may recommend you take calcium with a glass of orange juice -- some forms of calcium are better absorbed in an acidic environment. You can also add acid to your diet by squeezing lemon juice over leafy greens.Herbs
Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 to 2 heaping teaspoonfuls/cup water steeped for 10 to 15 minutes (roots need longer).
The following herbs are sometimes used to counter the bone loss that can occur from hyperparathyroidism, though scientific studies are lacking. Talk to your health care provider before taking any herbs if you have hyperparathyroidism.
- Chaste tree (Vitex agnus castus) standardized extract, 20 to 40 mg daily before breakfast, for support of the parathyroid gland. Chaste tree extract has many possible drug interactions and can have hormone-like effects in the body. People with a history of hormone-related conditions, or those who take hormone medications, should be particularly cautious. Speak with your physician.
- Dandelion (Taraxacum officinale) leaf tincture, 5 to 10 mL, 2 to 3 times a day, for its high mineral content. You can also prepare teas from the leaf. Certain drugs can interact with Dandelion, including lithium and some antibiotics. Speak with your physician. People with Ragweed allergies may also have an allergic reaction to Dandelion.
Although 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.
- Calcarea carbonica (calcium carbonate)
- Calcarea phosphorica (calcium phosphate)
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.
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, with cure rates of 94 to 96%. Minimally invasive surgery is associated with improvements in the cure rate (99.4%). 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. Various cardiovascular conditions are also associated with hyperparathyroidism.
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.
Adam MA, Untch BR, Danko ME, et al. Severe obesity is associated with symptomatic presentation, higher parathyroid hormone levels, and increased gland weight in primary hyperparathyroidism. J Clin Endocrinol Metab. 2010; 95(11):4917-4924.
Adler JT, Sippel RS, Schaefer S, Chen H. Surgery improves quality of life in patients with "mild" hyperparathyroidism. Am J Surg. 2009;197(3):284-290.
Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA . 2001;285:1482-1488.
Beers MH, Porter RS, et al, eds. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1254-1255, 1256, 1258-1259.
Belcher R, Metrailer AM, Bodenner DL, Stack BC. Characterization of hyperparathyroidism in youth and adolescents: a literature review. Int J Pediatr Otorhinolaryngol. 2013; 77(3):318-322.
Bringhurst FR, Demay MB, Kronenberg HM. Hormones and Disorders of Mineral Metabolism. In: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Textbook of Endocrinology, 12th ed. Philadelphia, PA: Elsevier Saunders. 2011.
Chertok-Shacham E, Ishay A, Lavi I, Luboshitzky R. Biomarkers of hypercoagulability and inflammation in primary hyperparathyroidism. Med Sci Monit. 2008;14(12):CR628-632.
Espiritu RP, Kearns AE, Vickers KS, Grant C, Ryu E, Wermers RA. Depression in primary hyperparathyroidism: prevalence and benefit of surgery. J Clin Endocrinol Metab. 2011; 96(11): E1737-E1745.
Fauci A , Kasper D, Longo DL, et al, eds. Harrison's Principals of Internal Medicine . 17th ed. [online version]. New York, NY: McGraw Hill; 2008.
Felger E, Kandil E. Primary Hyperparathyroidism. Otolaryngologic Clinics of North America. 2010;43(2):417-432.
Ferri FF. Ferri's Clinical Advisor. 1st ed. Philadelphia, PA: Elsevier Mosby; 2015:614-615.e1.
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;41(6):258-263.
Lindeman BM, Pesce CE, Tsai HL, et al. Lower vitamin D levels in surgical hyperparathyroidism versus thyroid patients. Am Surg . 2014;80(5):505-510.
Lydeking-Olsen E, Beck-Jensen JE, Setchell KD, Holm-Jensen T. Soymilk or progesterone for prevention of bone loss -- a 2 year randomized, placebo-controlled trial. Eur J Nutr . 2004;43(4):246-257.
NIH Osteoporosis and Related Bone Diseases National Resource Center. Information for Patients about Primary Hyperparathyroidism. National Institutes of Health.
Oleson CV, Seidel BJ, Zhan T. Association of vitamin D deficiency, secondary hyperparathyroidism, and heterotopic ossification in spinal cord injury. J Rehabil Res Dev. 2013; 50(9):1177-1186.
Traina AN, Kane MP, Bakst G, Busch RS, Abelseth JM, Hamilton RA. Efficacy of teriparatide in patients with resolved secondary hyperparathyroidism due to vitamin D deficiency. Endocr Pract. 2011;17(4):568-573.
Udelsman R, Lin Z, Donovan P. The superiority of minimally invasive parathyroidectomy based on 1650 consecutive patients with primary hyperparathyroidism. Ann Surg. 2011;253(3):585-591.
Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlove-Wuttke D. Chaste tree (Vitex agnus-castus) -- pharmacology and clinical indications. Phytomedicine . 2003;10(4):348-357.
Yen TW, Wang TS. Subtotal parathyroidectomy for primary hperparathyroidism. Endocr Pract. 2011;17(1):7-12.
Review Date: 12/6/2014
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network. Also reviewed by the A.D.A.M. Editorial team.