Hyperparathyroidism

There are three main types of hyperparathyroidism:

• Primary hyperparathyroidism. This is when one or more of the parathyroid glands are overactive and producing too much PTH.
• Secondary hyperparathyroidism. This is where a condition outside of the parathyroid glands causes the glands to produce too much PTH. These conditions may include kidney or renal failure, or vitamin D deficiency. 
• Tertiary hyperparathyroidism. Often, patients who have secondary hyperparathyroidism have treatment that addresses the underlying concern (i.e., a kidney transplant or dialysis to address kidney failure). Most of the time, after treatment is complete, the parathyroid glands return to normal function. However, in some people who experienced long-term kidney or vitamin D deficiency issues, the parathyroid does not return to its normal function and continues to produce too much PTH, acting like primary hyperparathyroidism. 

Less than 1% of hyperparathyroidism develops into parathyroid cancer.

The following factors may increase your risk of developing hyperparathyroidism:

• Being female
• Being over the age of 60
• Ongoing and severe vitamin D or calcium deficiencies
• Previous radiation therapy to the neck
• Using Lithium, a drug that helps treat bipolar disorder

Having a risk factor for hyperparathyroidism cancer doesn’t mean that you will get it, but it makes you more likely than someone without the risk factor. Talk to your doctor about your individual risk factors.  

It is common to be diagnosed with hyperparathyroidism before you notice any symptoms. That is because your healthcare provider may notice high levels of calcium during a routine blood test. 

As the body continues to overproduce PTH and cause too high calcium levels in the body, symptoms may include:

• Osteoporosis or brittle bones that break easily
• Bone and joint pain
• Kidney stones
• A general feeling of weakness or fatigue
• Depression or difficulty thinking
• Loss of appetite, nausea or vomiting
• Being more thirsty than usual
• Having to urinate more frequently than usual
• Constipation

The above symptoms can be related to a variety of medical conditions. It is important to talk to your doctor to determine the root cause of your symptoms. 

In very severe cases, elevated calcium levels in the blood due to hyperparathyroidism can cause kidney failure, loss of consciousness or life-threatening heart conditions. These symptoms are typically very rare.

There are a few different surgical options to remove overreactive parathyroid glands, or a growth on the parathyroid, including:

• Targeted parathyroidectomy. Also known as minimally invasive parathyroidectomy (MIP), your surgeon will remove the overreactive gland that was found in previous imaging studies, such as a 4D CT scan. With this type of surgery, the incision is typically very small and recovery times are shorter than with other types of procedures.
• Four gland parathyroid exploration. In this procedure, your surgeon makes an incision in the lower neck and examines your glands. Any glands that appear to be abnormal or enlarged are removed. In 96% of cases, there is only one enlarged parathyroid gland, and the other three are normal and do not require removal. 
• Partial parathyroidectomy. During a parathyroid exploration, if multiple glands are enlarged, your surgeon may remove up to three or three and a half of the glands so that part of the parathyroid tissue remains. This helps prevent your gland from producing too much PTH. 
• Total parathyroidectomy. During this procedure, all four of the glands are removed. In some cases, tissue from the parathyroid that is not impacted may be placed in your arm to allow for continued development of PTH.

Coverage varies by insurance carrier and plan. Contact your insurance carrier to learn more about your coverage specifics.