Hyperparathyroidism: symptoms, types and possible complications

Written by: Dr Samer Al-Sabbagh
Published: | Updated: 26/05/2020
Edited by: Laura Burgess

Hyperparathyroidism occurs when an excess of parathyroid hormone is released by the parathyroid glands in the neck. It can lead to high levels of calcium in the blood, which in turn can lead to a series of problems including kidney stones and you may be left feeling nauseous, exhausted and weak. We spoke to one of our expert consultant endocrinologists Dr Samer Al-Sabbagh about the symptoms of hyperparathyroidism and the possible treatment options.

A girl wearing a red jumper is lying sideways on a grey sofa using her arm to cover her eyes.

Where are the parathyroid glands?

We usually have four parathyroid glands. They are small, pea-sized glands, located in the neck just behind the butterfly-shaped thyroid gland.
 

What do people with hyperparathyroidism suffer from?

Overactive parathyroid glands generally lead to high levels of calcium in the blood. This hypercalcaemia (high calcium) can cause various symptoms, such as: 

  • Tiredness
  • Weak and easily tired muscles
  • Nausea (feeling sick), vomiting and feeling 'put-off by your food' 
  • Constipation
  • Abdominal pain
  • Feeling very thirsty and passing urine frequently
  • Depression, low mood and confusion
  • Kidney stones (small may be passed without noticing or large getting stuck, causing loin pain)
  • Bone pains
  • Pruritus (itchiness) and sore eyes
  • Other symptoms and complications
     

Why do we need calcium and phosphate?

Calcium and phosphate combine to make calcium phosphate in the body. This is the chief material that gives hardness and strength to the bones and teeth. Calcium is also needed as part of the complex mechanism that helps the blood to clot after an injury. As well, it is needed for the muscles and nerves to work properly. Phosphate works in conjunction with calcium for these functions. Phosphate is also needed for the production of energy within the body.
 

What are the different types of hyperparathyroidism?

Hyperparathyroidism could be:
 

Primary hyperparathyroidism

In primary hyperparathyroidism, one or more of your parathyroid glands become enlarged and overactive. The gland, or glands, release too much parathyroid hormone. This results in a high level of calcium in the blood.
 

Secondary hyperparathyroidism

The secondary type is caused by other diseases or deficiencies that are affecting the body such as kidney disease, vitamin D deficiency and intestinal malabsorption.
 

Tertiary hyperparathyroidism

This type of hyperparathyroidism occurs as a result of prolonged secondary hyperparathyroidism.
 

Is surgery necessary for hyperparathyroidism?

The majority of patients are asymptomatic, however, hyperparathyroidism can usually be treated with surgery if indicated.

The natural history of the disease is benign and stable in the majority of patients without complications, such as end-organ damage, but a minority of approximately 2-3% of patients will develop new indications for surgery annually.
 

What are the aims of investigations of people with hypercalcaemia?

When making a diagnosis of hypercalcemia, our aims are:

  1. To look into other causes of hypercalcaemia apart from hyperparathyroidism such as; hyperthyroidism (overactive thyroid), sarcoidosis, Addison’s, drug-related (Vitamin D/A intoxication, Thiazide Diuretic, Lithium), malignancy, familial hypercalcaemia and renal failure. This is so that we can confirm the diagnosis of primary hyperparathyroidism and exclude other causes (underlying illnesses).
     
  2. To determine complications (end-organ damage); This is why we need to do 24-hours urine collection for calcium, bone density scan and renal tract scan.
     
  3. Imaging the parathyroid glands once the diagnosis has been established by two different modalities of scans to try to match the findings and find out the responsible gland or glands. This will influence the surgical approach.
     

Are there any complications of hyperparathyroidism?

As aforementioned, not everyone with hyperparathyroidism gets complications. However, sometimes complications may develop if people have primary or tertiary hyperparathyroidism. These complications are mostly due to a long-standing high level of calcium in the blood. They can include:
 

Kidney stones

Small stones may be passed in the urine without you noticing. Larger stones may get stuck, causing pain in your loin area that radiates to the groin.
 

Corneal calcification

Calcium can be deposited (collect) in the cornea of the eyes. This doesn't usually cause any symptoms.
 

Pancreatitis

This is inflammation of the pancreas gland. Rarely, a high level of calcium due to hyperparathyroidism can cause pancreatitis. This can cause upper abdominal pain.
 

Peptic (stomach) ulceration

A high calcium level can stimulate the production of excess acid in your stomach and lead to stomach ulceration.
 

Kidney damage

A prolonged high calcium level in your blood can damage the kidneys and cause kidney failure.

In all types of hyperparathyroidism (including secondary hyperparathyroidism), the increased level of parathyroid hormone circulating in your blood causes high amounts of calcium to be released from your bones. This can cause weakness and the bones to become thin, which is a condition known as osteopenia. Bones may become painful and more susceptible to breaks or fractures.
 

What are the treatment options?

Depending on the individual case, treatment will involve observation and medical management. Surgery may be required in some cases.
 


Dr Al-Sabbagh specialises in treating thyroid disorders, adrenal gland disorders, diabetes, hypogonadism and pituitary tumours. You can book an appointment to see him here, via his Top Doctor’s profile.

By Dr Samer Al-Sabbagh
Endocrinology, diabetes & metabolism

Dr Samer Al-Sabbagh is a highly experienced consultant physician, diabetologist and endocrinologist at Spire Cambridge Lea Hospital and OSD Healthcare. His areas of expertise include thyroid gland disorders, adrenal disorders, diabetes, gonads and pituitary gland disease.

Dr Al-Sabbagh graduated from Damascus Medical School and completed post-graduate training in general medicine at Damascus University Hospitals. He then went on to research diabetic foot disease with Professor Andrew Boulton at Manchester Infirmary, before specialising in GIM, diabetes and endocrinology at Ipswich and Cambridge University Hospitals. He had his first consultant post at West Hertfordshire NHS Trust before moving to Guy’s and St Thomas NHS Trust. He joined East and North Hertfordshire NHS Trust in 2011.

Alongside his private practice, Dr Al-Sabbagh is currently the lead for diabetic feet, endocrine oncology and hyponatraemia for East and North Hertfordshire Trust and he is actively involved in teaching. Dr Al-Sabbagh has special interests in new therapies and technologies in diabetes and endocrine care and is a core member of the diabetes and endocrine outreach team who has recently won the national QiC award for best inpatient initiative in diabetes.

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