Calcium and Parathyroid Disorders

About

Causes

Symptoms

Diagnosis

Treatment

About

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What are parathyroid disorders?

Parathyroid disorders cause abnormally high or low blood levels of calcium and phosphorus. Calcium and phosphorus are important for muscle contractions and to transmit nerve signals. They also keep bones and teeth healthy. The disruption of normal levels of calcium and phosphorus can cause serious health problems, including brittle bones, fatigue, kidney stones, weakness, and other conditions. 

What are parathyroid glands?

Each of the four parathyroid glands are about the size of a grain of rice. Located near the thyroid gland, they are part of the body’s endocrine system, which produces and secretes hormones into your blood. Hormones control most bodily functions such as growth, reproduction, and metabolism.

What are the functions of parathyroid glands?

Properly functioning parathyroid glands can sense when calcium and phosphorus levels are too low or too high. When they’re too low, the glands release parathyroid hormone (PTH), which causes bones to release calcium into the bloodstream. It also signals the kidneys to increase vitamin D production to increase calcium absorption in the intestines. If calcium is too high, PTH production and secretion decrease.

Causes

What causes parathyroid disorders?

Parathyroid disorders can occur when PTH levels are too high (hyperparathyroidism), or too low (hypoparathyroidism).

What is hyperparathyroidism?

Hyperparathyroidism is caused by an overactive parathyroid gland that produces too much PTH. It’s usually caused by an enlargement of one or more parathyroid glands. If you have too much PTH in your blood it causes blood calcium to rise (hypercalcemia). This increase can be caused by your body releasing extra calcium from your bones into your blood; your intestines absorbing more calcium from food; or your kidneys retaining calcium that is sent back into your bloodstream instead of secreting it in urine.

There are two types of hyperparathyroidism, primary and secondary.

Primary hyperparathyroidism is caused when your parathyroid glands produce and release too much PTH, as they work to keep your calcium levels normal. This can be caused by:

  • A non-cancerous growth on one parathyroid gland that causes the gland to overreact and make more PTH is the most common cause
  • Enlargement of two or more parathyroid glands (hyperplasia)
  • Radiation to the neck area
  • Taking lithium
  • Cancer of the parathyroid gland
  • Genetic conditions

Secondary hyperparathyroidism can occur when another health condition causes calcium levels to decrease. When calcium levels drop, the parathyroid compensates by producing more calcium. Although it initially decreases calcium levels, over time, PTH levels can increase. It can be caused by:

  • Severe calcium and/or vitamin D deficiencies
  • Chronic kidney disease or kidney failure

Hypoparathyroidism — the opposite of hyperparathyroidism — can occur when the parathyroid glands don’t produce enough PTH. It can be caused by:

  • Surgery to remove the glands, or glands damaged during surgery. This is the most common cause, and can happen years after neck surgery.
  • Autoimmune disease or endocrine conditions such as Addison’s Disease, which can slow the glands’ hormone production
  • Acute illness, including kidney disease or pancreatitis
  • Low blood level of magnesium
  • Cancer radiation treatment of face or neck
  • Genetic issues such as being born without parathyroid glands or glands that don’t work correctly

Who’s at highest risk for parathyroid disorders?

Hypoparathyroidism is much less common than hyperparathyroidism.

Your risk of developing hyperparathyroidism is greater if you:

  • Are female — women are twice as likely as men to be one of the more than 100,000 new cases of hyperparathyroidism diagnosed annually in the United States
  • Are over age 50
  • Are postmenopausal
  • Have had neck radiation

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Symptoms

What are the symptoms of parathyroid disorders?

When the disease first begins, there are rarely any symptoms. If symptoms occur, it’s because of damage to, or dysfunction in other parts of the body. This can be caused by the long-term effects of too much calcium in the blood and too little calcium in bones.

Symptoms of mild hyperparathyroidism can include:

  • Joint and bone pain
  • Muscle weakness
  • Fatigue
  • Depression and anxiety
  • Trouble concentrating and memory problems
  • Loss of appetite
  • Stomach pain
  • Difficulty sleeping

Symptoms of more severe hyperparathyroidism include:

  • Osteoporosis, which causes bones to break easily, and also contributes to kidney stones, decreased kidney function, heart disease, pancreatitis, increased stomach-acid secretion, and ulcers
  • Heart disease and high blood pressure
  • Bone pain
  • Kidney stones; reduced kidney function
  • Nausea and vomiting
  • Increased thirst and urination
  • Constipation
  • Confusion and forgetfulness

Hypoparathyroidism symptoms can include:

  • Muscle aches or cramps
  • Tingling or burning in fingertips, toes and lips
  • Twitching or muscle spasms around the mouth, hands, arms and throat
  • Nerve function problems
  • Fatigue
  • Hair loss
  • Dry, course skin
  • Brittle nails
  • Unusual involuntary movements
  • Depression or anxiety

Some symptoms of hypoparathyroidism, which cannot be reversed with calcium and vitamin D supplements, include:

  • Stunted growth
  • Slow mental development in children
  • Clouded vision due to cataracts
  • Calcium deposits in the brain that can cause balance problems and seizures

Diagnosis

How are parathyroid disorders diagnosed?

There may not be any symptoms, or they’re not noticed because they are common to many other conditions. It’s easy to miss a parathyroid-disorder diagnosis.

Your doctor will take your health history and symptoms, and do a physical exam. Additional testing may include:

  • Blood test to determine calcium, phosphorus, PTH and vitamin D levels, and check if your kidneys are working properly
  • Check for enlargement of, or growths on parathyroid glands
  • Ultrasound to check for kidney stones
  • Bone density test to check for bone loss (osteoporosis)
  • Urine may be collected for 24 hours to measure calcium levels
  • MRI or CT scans may be done if a parathyroid disorder is diagnosed

Treatment

How are parathyroid disorders treated?

For milder hyperparathyroidism cases, the only treatment may be:

  • Regular monitoring of your calcium and phosphorus levels
  • Checking for bone loss
  • Replacing vitamin D
  • Drinking lots of water
  • Staying active to keep bones strong
  • Avoiding thiazide diuretics and lithium

If your parathyroid gland is enlarged, or your symptoms severe, you may need:

  • Surgery, which can cure most (95%) hyperparathyroidism
  • Regular checks of your PTH level after surgery
  • Bone density test annually
  • Medications to control PTH production, or prevent calcium loss from bones
  • Postmenopausal women may take hormone replacement therapy to help bones retain calcium, or other bone-specific medications

Treatment for hypoparathyroidism is calcium and phosphorus supplements to normalize your levels. Depending on the cause, you may need to take supplements for life.

At Inland Endocrine, our highly trained specialists provide the individual care and attention that speeds recovery from parathyroid disorders. Call today for an appointment with Inland Endocrine’s treatment team.

References

University of Michigan Health. N.d. Parathyroid Disorders. Retrieved 7-7-21, {https://www.uofmhealth.org/conditions-treatments/endocrinology-diabetes-and-metabolism/parathyroid-disorders}
Cleveland Clinic. N.d. Hyperparathyroidism. Retrieved 7-7-21,  {https://my.clevelandclinic.org/health/diseases/14454-hyperparathyroidism}
Michels, TC and Kelly, KM. 2013. Parathyroid Disorders. American Family Physician. Retrieved 7-8-2021, {https://www.aafp.org/afp/2013/0815/p249.html} 
Mayo Clinic. 2020. Hyperparathyroidism. Retrieved 7-8-2021, {https://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/symptoms-causes/syc-20356194}
Mayo Clinic. 2020. Hypoparathyroidism. Retrieved 7-8-2021, {https://www.mayoclinic.org/diseases-conditions/hypoparathyroidism/symptoms-causes/syc-20355375}

Medically reviewed by:

Stuart Seigel, MD

Dr. Seigel is a board certified Endocrinologist. He completed his residency in internal medicine and fellowship in endocrinology, diabetes and metabolism at the University Of Pittsburgh Medical Center in 2011 and 2013.

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