Introduction to Hyperparathyroidism Symptoms
Hyperparathyroidism is when the parathyroid glands start producing excess amounts of the parathyroid hormone (PTH). When hormone levels increase, it can cause calcium levels in the bloodstream to rise, which may lead to a variety of symptoms. If the condition progresses without treatment, it can shorten a person’s life expectancy and quality of life.
Primary hyperparathyroidism occurs when a benign tumor forms on one of the four parathyroid glands, affecting the gland’s ability to regulate blood calcium levels. Secondary hyperparathyroidism is characterized by high blood calcium levels due to other reasons, such as kidney disease or vitamin D deficiency. Symptoms of secondary hyperparathyroidism are similar to those of primary hyperparathyroidism, but treatment involves addressing the underlying cause of the calcium imbalance.
The ability to identify and diagnose hyperparathyroidism is essential to starting treatment early and preventing long-term damage to the body. However, symptoms of hyperparathyroidism are often vague and wide-ranging, making it difficult to pinpoint hyperparathyroidism as the cause. Finding a parathyroid expert who can put the symptoms together with blood test results is critical to getting a diagnosis as quickly as possible.
Common Symptoms of Hyperparathyroidism
The list of common symptoms of hyperparathyroidism is extensive and can be attributed to numerous other conditions. Signs and symptoms of hyperparathyroidism might include:
- Persistent fatigue
- Problems with focus or concentration
- Forgetfulness or memory issues
- Bone or joint pain
- Muscle aches or weakness
- Depression and anxiety
- Stomach pain and constipation
- More frequent urination
- Difficulties sleeping
- Hair loss
When you ask a parathyroid patient about their symptoms, they may explain that they no longer feel like themselves. Many patients say they feel old, their body aches, or don’t have the same zest for life. For some patients, these symptoms are obvious; for others, they are less pronounced. Because the symptoms of hyperparathyroid disease are so nonspecific and patients can experience any combination of symptoms, a lot of patients are not properly diagnosed as having a parathyroid disorder and continue to live in pain. That’s why it is crucial to find a parathyroid expert to correctly diagnose the condition and start the correct treatment path to better health.
I struggled unsuccessfully for months to find a local surgeon who could diagnose my hyperparathyroidism and was fortunate enough to learn about Dr. Larian while doing my own research. Few doctors are knowledgeable about parathyroid disease, even fewer can perform the surgery successfully using minimally invasive procedures.” – Jennifer, Washington D.C.
Subtle and Severe Signs of Hyperparathyroidism
There are also signs and symptoms of hyperparathyroidism that can be more severe, particularly if the condition is not treated early. These symptoms can be caused by high blood calcium levels and could include:
- Nausea and vomiting
- Dehydration
- Cardiac arrhythmias
- Heart palpitations
- Elevated blood pressure
- Kidney stones
- Kidney disease or failure
Every cell in our body uses calcium to function properly, which means having high calcium levels can cause a wide range of symptoms. However, the severity of symptoms does not always correlate to the body’s calcium level. This means you do not necessarily need to have high calcium levels in order to experience extreme symptoms, or you may also have very high levels of calcium with almost no symptoms present.
Bone and Joint Health Implications
Hyperparathyroidism can affect different areas of the body, including the bones and joints. Joint pain is a common complaint, and arthritis of the major joints can occur. Bones can also weaken, leading to a condition known as osteoporosis. Weak bones can fracture easily, creating significant hazards for someone with hyperparathyroidism.
Impact on Kidney Function
When the parathyroid glands function normally, they release PTH into the kidneys to tell the organs to take calcium out of the urine and put it back into the bloodstream. Too much PTH can trigger kidney stone production, which may harm kidney function. Over time, this can lead to urinary tract infections, kidney disease or even kidney failure in the advanced stages.
Cognitive and Emotional Effects
Uncontrolled calcium and PTH levels can also affect the nervous system, making it sluggish and leading to a variety of cognitive and psychological symptoms. People with hyperparathyroidism may have difficulty concentrating and remembering things and may even worry they are developing dementia. Psychological symptoms of hyperparathyroidism might include depression and anxiety.
Diagnostic Challenges
It is easier for inexperienced providers to explain hyperparathyroidism than to diagnose it. A doctor may see an elevation in blood calcium and PTH levels during a blood test. This is the easiest type of hyperparathyroidism to diagnose, particularly when accompanied by some of the common symptoms of the disease.
However, some patients may present with elevated calcium levels but normal PTH levels, or vice versa. This can muddy the diagnostic waters considerably for providers who are not experts in this area. At the same time, the severity of symptoms does not necessarily correlate to the severity of the disease, making it impossible to know how long the condition has been present.
Diagnostic Tests and Procedures
Because of the variations in calcium and PTH levels, as well as differentiations in the symptoms of hyperparathyroidism, there is no one-size-fits-all diagnostic process for this condition. A parathyroid expert like Dr. Larian will personalize the diagnostic process, looking at the relationship between PTH and calcium levels, symptoms, and perform additional comprehensive testing.
Once Dr. Larian determines hyperparathyroidism is present, he conducts a four-gland assessment to identify whether there is one or more affected glands. The only cure for hyperparathyroidism is to remove the abnormal gland. Dr. Larian specializes in a minimally invasive parathyroidectomy (MIP) to remove the gland while protecting surrounding tissue. The procedure uses a smaller incision and can be performed as an outpatient procedure using local anesthesia.
Calcium Levels & Your Parathyroid Symptoms
The severity of your symptoms does not always correlate your calcium levels. Therefore, it is possible to have debilitating symptoms with only a slight elevation in calcium levels on laboratory testing. Alternatively, you could have very high calcium levels and experience little to no symptoms. In the table below, the frequency of symptoms is listed and compared when calcium is less 11.2 mg/dL to more then 11.2 mg/dL (essentially 1 unit above the laboratory normal). And it clearly shows the frequency of symptoms not being affected by the calcium level alone.
Bargren AE, et al. Can biochemical abnormalities predict symptomatology in patients with primary hyperparathyroidism? J Am Coll Surg. 2011;2013:410-414.
The reason for this is that the degree of symptoms has to do with how much of an increase you have had in calcium compared to the level your body wanted your calcium to be years ago before you had hyperparathyroidism. So if your body prefers calciums in the lower end of normal (laboratory normal range) then being only slightly above normal is a huge increase; for example if your calciums liked being around 8.8-9.0 and now it’s between 10.2-10.4, that is a huge increase.
What does this mean? Do not let your calcium level alone fool you or your physician into thinking that you do not have parathyroid disease! Hyperparathyroidism may present in many different forms on laboratory tests, such as normocalcemic or normohormonal hyperparathyroidism shown in the table below. These are not different diseases but rather different ways hyperparathyroidism presents on laboratory tests. your calcium and/or PTH levels show an imbalance and are even slightly elevated, and you are having some symptoms consistent with hyperparathyroidism, it is time to find a parathyroid specialist, like Dr. Larian, who can properly diagnose you. Dr. Larian has extensive experience in diagnosing patients based on their symptoms, calcium levels, and PTH levels, and has seen countless manifestations of the disease. Many of the patients we see here at the CENTER have gone years without being diagnosed, and we are able to diagnose them during their first inoffice, or even Skype, consultation. We will not tell you that your calcium is “not that high” or to “wait a few more months or another year to see if the levels come down” because we know the parathyroid tumor will not go away on its own and therefore there is no reason to delay treatment.
Hyperparathyroidism Symptoms FAQ
What happens if hyperparathyroidism is left untreated?
Since HPT is caused by a hormonal imbalance that causes increased production of PTH (more than your body’s needs), there is continued loss of calcium from bones. Even if the laboratory tests don’t show the calcium to be going up, and the person doesn’t develop kidney stones, the bone loss progresses in the majority of people who have HPT. However, as the person who has HPT continues to go untreated, the majority of symptoms continue to progress and get worse in time.
Can You Die From Hyperparathyroidism?
Yes, but it is not caused usually directly by increased calcium or PTH but rather by the impact of this disease on other organs such as the kidney and the heart.
Can Symptoms Alone Be Used as the Reason to Treat Hyperparathyroidism?
This is a subject of great controversy. So much so that there is an international workshop that reviews the literature to try to answer this question. There is clear evidence that if kidney stones, or bone loss are present then surgery is absolutely indicated. In terms of other symptoms the answer is not so clear. And that is because there are as many articles showing great improvement of symptoms with treatment as there are showing minimal improvement. However, what remains important is for the person who has hyperparathyroidism to consider the impact of the disease on their own body; if they can clearly feel that their quality of life is being affected then they should take action. The article below has a good summary of the research.
Can Hyperparathyroidism Be Cured Permanently?
Hyperparathyroidism caused by a parathyroid adenoma can be cured.
Does Osteoporosis Improve After Parathyroid Surgery?
An elegant study by the group at Columbia University which was done over a period of 24 years, showed that all (100%) the patients that had parathyroid surgery had improvement of their bone density. This improvement was present even 15 years after surgery.
Does Hyperparathyroidism Increase The Risk of Developing Cancer?
There are multiple studies showing hyperparathyroidism is associated with increased risk of cancer development. The incidence of breast, skin and kidney tumors significantly increased in the 10 years prior to treatment of hyperparathyroidism.
Find Out If You Have Hyperparathyroidism Today!
Hyperparathyroidism is difficult to diagnose and delicate to treat. Unfortunately, the complexity of hyperparathyroidism has left many patients suffering for years with discomfort and the potential for devastating, irreversible complications.
Dr. Babak Larian is board-certified in otolaryngology and has extensive experience and expertise in diagnosing and treating hyperparathyroidism at the Center for Advanced Parathyroid Surgery. Don’t suffer any longer. Contact us today to learn more about this condition or schedule your consultation with one of our specialists.
