Primary hyperparathyroidism explained

What primary hyperparathyroidism is

The parathyroid glands are four tiny glands, each about the size of a grain of rice, sitting in the neck near the thyroid gland. Their job is to control the level of calcium in the blood by producing parathyroid hormone, which raises calcium when it is low. In primary hyperparathyroidism, one or more of these glands becomes overactive and makes too much of the hormone even when calcium is already normal or high, so the blood calcium level rises above where it should be. The overactivity is most often caused by a small, non-cancerous growth on one gland, and less commonly by several glands enlarging. It becomes more common with age and is more frequent in women. The raised calcium and hormone, over time, are what lead to the effects on the body.

The symptoms it causes

Many people with primary hyperparathyroidism have mild disease and few or no symptoms, and it is picked up on a blood test. When symptoms do occur, they come mainly from the raised calcium level and can be vague and easy to attribute to other things. They include tiredness, low mood or feeling depressed, difficulty concentrating or feeling foggy, increased thirst and passing more urine, constipation, tummy discomfort, and aches in the bones and muscles. Over the longer term, too much parathyroid hormone can weaken the bones, making them more fragile and prone to fracture, and the raised calcium can lead to kidney stones or affect kidney function. An old medical saying that the condition can cause problems with bones, stones, tummy groans and psychological moans captures this range of possible effects.

How it is diagnosed

Primary hyperparathyroidism is usually suspected when a blood test shows a raised calcium level. To confirm it, doctors measure the parathyroid hormone level at the same time: in this condition the hormone is inappropriately high or in the upper range despite the raised calcium, which points to overactive glands rather than another cause of high calcium. Further blood and urine tests help confirm the picture and check kidney function and vitamin D. Once the diagnosis is made, tests such as a bone density scan and kidney imaging may be done to look for effects on the bones and kidneys. If surgery is being considered, special scans are used to try to locate which gland or glands are overactive. Diagnosis and assessment are usually guided by a specialist in hormone conditions.

How it is managed

How primary hyperparathyroidism is managed depends on how high the calcium is, whether there are symptoms, and whether the bones or kidneys are affected. For mild disease without symptoms or complications, careful monitoring with regular blood tests and checks on the bones and kidneys may be all that is needed, along with general advice such as staying well hydrated and keeping active. The main definitive treatment is an operation to remove the overactive gland or glands, which cures the condition in most people and can improve symptoms and protect the bones and kidneys; this is usually recommended when calcium is significantly raised, when there are symptoms or complications, or in younger people. Where surgery is not suitable, medicines can help control the calcium level. Ensuring adequate vitamin D is also part of care, guided by specialists.

Living with primary hyperparathyroidism

Whether you are being monitored or have had treatment, living with primary hyperparathyroidism involves some simple, practical steps. Staying well hydrated by drinking enough fluids helps, as does keeping physically active, which is good for the bones. It is sensible to be aware of symptoms that might suggest a rising calcium level, such as increased thirst, passing lots of urine, constipation, tummy upset, tiredness or confusion, and to seek advice if these develop or worsen. Attending monitoring blood tests and bone and kidney checks is important where the condition is being watched rather than operated on. If you have surgery, calcium is checked closely afterwards, as the level can dip temporarily. Discussing any concerns, including bone health and kidney stones, with your specialist team helps tailor care, and most people do very well, particularly after successful surgery.