Hyperparathyroidism  (Overactive Parathyroid)

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What is hyperparathyroidism  (overactive parathyroid)? 

Hyperparathyroidism, also known as overactive parathyroid, happens when the parathyroid gland produces parathyroid hormone (PTH) in excessive amounts. The parathyroid glands are four tiny, pea-sized glands located behind the thyroid gland in the neck. 

These glands play a crucial role in regulating and balancing the calcium levels in the blood. However, when these glands become overactive and produce too much PTH, they result in increased calcium levels in the blood, leading to various health problems. 

What causes hyperparathyroidism  (overactive parathyroid)?

Hyperparathyroidism or overactive parathyroid can be caused by various factors depending on the type of hyperparathyroidism: 

There are two types of hyperparathyroidism:

  • Primary hyperparathyroidism: primary hyperparathyroidism is mainly caused by a benign tumour in either one or more parathyroid glands. The tumour or enlargement (adenoma) in the parathyroid glands causes excessive PTH, which results in elevated calcium levels in the blood, a condition known as hypercalcaemia. 
  • Secondary hyperparathyroidism: also known as renal hyperparathyroidism, is a type of hyperparathyroidism that is primarily a result of an underlying health condition that lowers the level of calcium in the blood. As a result, the parathyroid gland becomes overactive to regulate the imbalances in the calcium levels. Secondary hyperparathyroidism is usually caused by chronic kidney diseases when the kidneys are unable to make active vitamin D. Insufficient vitamin D levels interfere with calcium absorption, which results in stimulating the parathyroid glands. 

However, the causes of hyperparathyroidism may vary from one individual to another. In some cases, the exact cause may not be clear. 

If you are experiencing symptoms associated with hyperparathyroidism, consult with an endocrinologist for a proper diagnosis and timely treatment of the condition. 

What are the symptoms of hyperparathyroidism? 

Hyperparathyroidism can cause various symptoms, depending on the type and severity of the condition. While some individuals may experience mild or no symptoms, others may experience severe and various symptoms, including: 

  • Fatigue: patients suffering from hyperparathyroidism may experience extreme fatigue and lack energy. 
  • Weakness: one of the common symptoms of hyperparathyroidism is muscle weakness, specifically in the limbs. 
  • Body pain: individuals suffering from hyperparathyroidism may experience joint pain, muscle aches, and bone pain. In some cases, patients with hyperparathyroidism may also develop osteoporosis or fractures. 
  • Kidney stones: individuals with hyperparathyroidism may be at risk of developing kidney stones caused by high calcium levels in the blood, resulting in severe pain in the abdomen and lower back area. 
  • Frequent urination: increased calcium levels in the blood can cause frequent urination. Individuals suffering from hyperparathyroidism may also experience excessive thirst. 
  • Gastrointestinal symptoms: nausea, abdominal pain, vomiting, and constipation are common gastrointestinal issues associated with hyperparathyroidism. 
  • High blood pressure: increased calcium levels in the blood may also result in hypertension (high blood pressure). 
  • Osteoporosis: if left untreated, hyperparathyroidism can weaken the bones, resulting in an increased risk of fractures. 
  • Mental and emotional symptoms: some individuals with hyperparathyroidism may experience depression, anxiety, or cognitive difficulties.
  • Cardiovascular issues: in some rare and severe cases, hyperparathyroidism may even affect the heart, which may result in palpitations or arrhythmias
Fatigue
Hyperparathyroidism can result in excessive fatigue and lack of energy. 

However, not everyone with hyperparathyroidism experiences all of these symptoms, and some patients may even be asymptomatic. 

Is hyperparathyroidism painful? 

Hyperparathyroidism itself is not painful; however, it can lead to symptoms that may cause pain or discomfort among some individuals. The effects of hyperparathyroidism in different parts of the body usually cause the pain. 

For example, increased parathyroid hormone levels can release calcium from the bones, which can cause bone pain, muscle aches, body pain, and muscle weakness. Similarly, kidney stones caused due to high blood calcium levels can also cause severe pain. 

However, not everyone suffering from hyperparathyroidism experiences pain, as the severity of these symptoms varies from one person to another. 

Who is at risk of hyperparathyroidism in Singapore? 

While hyperparathyroidism can affect individuals from all backgrounds and ages, certain factors may increase the chances of developing this condition. Some of the risk factors associated with hyperparathyroidism include: 

  • Age: although hyperparathyroidism can occur at any age, it is usually more common among the ageing population in Singapore, especially those above 60 years. 
  • Gender: women are generally found to be affected by hyperparathyroidism more as compared to men. 
  • Previous parathyroid conditions: individuals with a medical history of parathyroid gland issues, such as benign tumours or overactive parathyroid glands, are at an increased risk of developing hyperparathyroidism. 
  • Family history: individuals with a family history of hyperparathyroidism or related conditions are more at risk of developing the condition as there may be a genetic component to this condition. 
  • Radiation exposure: previous exposure to neck or head radiation, especially during childhood, is known to be a risk factor for parathyroid tumours. 
  • Some medical conditions: medical conditions that affect calcium absorption, such as chronic kidney disease and vitamin D deficiency, can increase the risk of secondary hyperparathyroidism. 
  • Medications: the long-term usage of some medicines, such as lithium, can negatively impact the parathyroid function and increase the risk of hyperparathyroidism. 

How is hyperparathyroidism (overactive parathyroid) diagnosed? 

Hyperparathyroidism is usually diagnosed through a combination of blood tests, scans, imaging tests, and medical evaluation by your endocrinologist

  • Blood tests: at the initial stage, blood tests are usually administered to measure the levels of parathyroid hormone (PTH) and calcium in the blood. Elevated calcium and PTH levels may indicate the overactivity of the parathyroid glands and confirm the diagnosis of hyperparathyroidism. 
  • Imaging studies: the use of imaging studies is one of the common methods for diagnosing hyperparathyroidism.
    • Sestamibi scan: a sestamibi scan is a nuclear medicine imaging test that helps identify which parathyroid gland(s) is overactive. A small amount of sestamibi, a radioactive material, is injected into the parathyroid glands. Sestamibi is easily absorbed by an overactive parathyroid gland, which is detected by a scanner or a camera during the scan. 
    • Ultrasound: an ultrasound of the neck is usually recommended to check the parathyroid glands and detect any abnormalities or enlargement in these glands. 
    • Additional tests: depending on the results of the initial evaluation and tests, further imaging tests, such as a computed tomography (CT) scan or magnetic resonance imaging (MRI), may be recommended to assess the parathyroid and the surrounding glands in more detail. 
  • Thorough medical evaluation: your endocrinologist will thoroughly examine your symptoms, physical condition, and results of the tests to diagnose your condition and suggest appropriate treatment for your case. 
Ultrasound
Ultrasound helps assess the parathyroid glands for abnormalities and enlargement for diagnosing hyperparathyroidism.

What are the treatment options for hyperparathyroidism in Singapore? 

The treatment of hyperparathyroidism varies depending on the type and underlying cause of the condition. Some common treatment options for hyperparathyroidism include: 

  • Observation and monitoring: regular monitoring of calcium levels and symptoms may be recommended as the first treatment option for asymptomatic and mild primary hyperparathyroidism cases with no significant complications. The aim is to make sure the condition does not worsen with time. 
  • Surgery: surgery may be necessary for both primary and secondary hyperparathyroidism.
    • Primary hyperparathyroidism: the surgical removal of the overactive parathyroid gland(s) is the most common and effective treatment for primary hyperparathyroidism. The aim is only to remove the affected gland and preserve the well-functioning parathyroid glands. 
    • Secondary hyperparathyroidism: in case other treatments are ineffective, surgery may even be prescribed for secondary hyperparathyroidism. 
  • Medications for secondary hyperparathyroidism: if hyperparathyroidism is caused by chronic kidney disease, your endocrinologist may prescribe medications, such as vitamin D analogues or calcimimetics, to regulate calcium and PTH levels. 
  • Dietary and lifestyle changes: maintaining a healthy lifestyle and following dietary guidelines is highly recommended, irrespective of the type of hyperparathyroidism. A diet that improves bone health, adequate hydration, and proper nutrition is generally recommended to improve the symptoms. 
  • Managing the associated complications: in case hyperparathyroidism has resulted in complications, such as kidney stones or osteoporosis, treatment options may be necessary for treating those conditions to improve the symptoms. 
high calcium diet
A diet high in calcium can help improve bone health and the symptoms associated with hyperparathyroidism.

However, the treatment choice depends on an individual’s specific condition, the severity of their symptoms, and the associated complications. 

In the case of secondary hyperparathyroidism, the treatment may be focused on managing the condition rather than curing it, while surgery may be recommended in the case of primary hyperparathyroidism. 

If you are suffering from hyperparathyroidism, schedule an appointment with ACE Specialist Surgery and Endoscopy to determine the most suitable treatment plan for your condition. 

Frequently Asked Questions

Can hyperparathyroidism be prevented?

Hyperparathyroidism may not always be prevented, but maintaining a healthy lifestyle with a balanced diet, proper hydration, and regular exercise can support bone health and potentially reduce the risk of complications associated with hyperparathyroidism. 

Are there any long-term complications associated with untreated hyperparathyroidism?

Yes, untreated hyperparathyroidism can lead to severe complications, including osteoporosis, fractures, kidney stones, and cardiovascular issues. Timely diagnosis and appropriate treatment are essential to prevent these complications.

Can hyperparathyroidism recur after treatment?

In some cases, hyperparathyroidism can recur after surgery. To avoid and detect any recurrence early, follow up with your endocrinologist for regular monitoring, as recurrent cases may require additional treatment.

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Reyaz Moiz

Dr Reyaz Singaporewalla
Senior Consultant Endocrine and General Surgeon

MBBS (Bom), MS (Surg), DNB (Surg), FRCS (Edin), MMed (Singapore), FRCSEd.