Hyperparathyroidism 

Introduction
Hyperparathyroidism is a condition that results when the parathyroid glands produce excessive amounts of hormones.  The parathyroid glands are located next to the thyroid gland at the front of your neck.  Hyperparathyroidism may or may not produce symptoms.  The condition is treated with supplements, medication, or surgery.

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Anatomy
Your four parathyroid glands are located behind the thyroid gland, which is located at the front of your neck.  The parathyroid glands produce hormones that regulate the amount of calcium, Vitamin D, and phosphorus in your body.  When the calcium levels are too low, your parathyroid glands release hormones to help restore the proper level.  Calcium is not only important for strong bones but for healthy nerve conduction, heart functioning, blood pressure, and muscle movement as well.  Phosphorus assists calcium with these functions.  One of the roles of Vitamin D is to help replenish calcium levels in the body.

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Causes
Hyperparathyroidism occurs when the parathyroid glands produce too much parathyroid hormone.  As a result, there is too much calcium in the blood and not enough phosphorus.  If the calcium levels become too high, a condition called hypercalcemia can result. 

There are a few types of hyperparathyroidism and they are treated differently.  Primary hyperparathyroidism is caused by enlargement of the parathyroid glands.  Secondary hyperparathyroidism is caused by another condition, such as kidney failure, rickets (Vitamin D deficiency), or absorption problems in the intestines, which creates low calcium levels.  Tertiary hyperparathyroidism occurs when the parathyroid glands produce too much calcium after there is adequate calcium in the body.  Tertiary hyperparathyroidism occurs most frequently in people with kidney failure.

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Symptoms
Hyperparathyroidism may or may not cause symptoms.  Symptoms tend to develop gradually over time.  You may feel tired and have joint aches, muscle weakness, and back pain.  You may not feel hungry but feel thirsty.  You may urinate more frequently than before.  Osteoporosis, thinning bones, may contribute to fractures.  You may develop kidney stones or abdominal pain.  You may experience nausea or vomiting. 

Hyperparathyroidism can also cause changes in the way you think.  It may be more difficult to remember things than it was before.  You may feel depressed and confused. 

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Diagnosis
You should contact your doctor if you suspect that you have hyperparathyroidism.  Usually it is diagnosed during routine blood examinations.  Hyperparathyroidism may be diagnosed with blood tests, urine tests, and imaging tests.  A bone density test may be used to evaluate your risk of fractures and degree of osteoporosis.  A Sestamibi test and neck ultrasound is used to check the size and shape of the parathyroid glands.  The Sestamibi test uses a small amount of a radioactive substance to highlight abnormal areas of the gland on images.

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Treatment
The treatment that you receive depends on the severity and type of hyperparathyroidism that you have as well as your age.  Mild cases of primary hyperparathyroidism may just need regular monitoring by your doctor.  If your calcium levels should increase, surgery to remove the gland or glands may be necessary.  The parathyroid glands may be removed with traditional open surgery or minimally invasive parathyroidectomy (MIP).
 
Traditional surgery involves using a large incision to reach and explore the glands.  The newer procedure, MIP, is less invasive and performed through a small incision.  The abnormal gland is identified prior to surgery with a Sestamibi test and neck ultrasound.  A short-acting general anesthesia and local anesthesia are used for the surgery.  MIP surgery is associated with a quicker recovery time than traditional surgery.  MIP surgery may require an overnight stay or some people may go home on the same day.  Traditional surgery typically requires a stay of a few days in the hospital.
 
Secondary hyperparathyroidism is treated with calcium and vitamin D.  Any underlying medical conditions are controlled as much as possible.  Prescription medications maybe used to help reduce the excess parathyroid hormone production in people with kidney failure. 

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Prevention
You may help reduce your risk of hyperparathyroidism by including adequate amounts of vitamin D and calcium in your daily diet.  Ask your doctor if supplements are appropriate for you.  It can help to stop smoking, drink plenty of water, and exercise regularly.

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Am I at Risk

Hyperparathyroidism is much more common in woman than in men.  It occurs most frequently in people over the age of 65.


Risk factors for hyperparathyroidism include:


_____ Increasing age is associated with an increased risk of hyperparathyroidism.
_____ People with a vitamin D deficiency are at risk for developing hyperparathyroidism.
_____ In some cases, hyperparathyroidism may be inherited genetically.  People with familial
 hyperparathyroidism have an increased risk for developing the condition.
_____ Multiple endocrine neoplasia type I is a rare inherited disorder that increases the risk of   developing hyperparathyroidism.
_____ People with certain medical conditions, including rickets, kidney failure, malabsorption syndrome, parathyroid gland cancer, or enlarged parathyroid glands have an increased risk of hyperparathyroidism.

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Complications
Too much calcium in the blood can cause hypercalcemia.  Hypercalcemia needs to be treated aggressively to avoid serious medical complications.

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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on April 13th, 2016. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.