Primary Hyperparathyroidism

Primary hyperparathyroidism occurs when one or more of the four parathyroid glands in the neck produce too much parathyroid hormone, which raises the level of calcium in the blood. In about 85 per cent of cases the cause is a single benign growth called an adenoma.

It is often found by chance on a routine blood test. Over years the excess hormone thins the bones and promotes kidney stones. Surgery is the only cure, and in experienced hands it succeeds in over 95 per cent of patients.

Symptoms

• No symptoms in many people
• Tiredness, low mood, poor concentration
• Thirst and passing urine often
• Constipation, nausea, abdominal pain
• Bone and joint aches
• Kidney stones
• Fragility fractures or osteoporosis on a bone scan

Causes and risk factors

A single adenoma is the usual cause, enlargement of all four glands accounts for most of the remainder, and cancer of a parathyroid gland is very rare. Most cases are sporadic. It is two to three times more common in women, particularly after the menopause. Earlier radiation to the neck and long-term lithium treatment increase risk. Young patients, or those with affected relatives, may have an inherited syndrome such as multiple endocrine neoplasia type 1 or 2A, which changes the surgical plan.

How it is diagnosed

• Blood calcium and parathyroid hormone: A raised calcium with a raised or inappropriately normal PTH makes the diagnosis.
• Vitamin D and kidney function: Low vitamin D can mask or mimic the picture and is corrected carefully.
• 24-hour urine calcium: Excludes familial hypocalciuric hypercalcaemia, a harmless inherited condition that does not need surgery.
• DEXA bone density scan: Includes the forearm, which is affected early.
• Kidney ultrasound or CT: Looks for silent stones.
• Localisation imaging: Neck ultrasound with sestamibi SPECT-CT, or 4D-CT or choline PET when these are negative. Imaging guides the surgeon; it does not make the diagnosis.

Treatment options

• Parathyroidectomy: Removal of the overactive gland, often through a 2 to 3 centimetre incision with PTH measured during the operation to confirm success. Four-gland exploration is used for multigland disease.
• Monitoring: For mild cases in people over 50 without stones or osteoporosis: annual calcium, kidney function and bone density every one to two years.
• Cinacalcet: Lowers calcium in those who cannot have surgery, without protecting bone.
• Bone protection: Bisphosphonates or denosumab for osteoporosis when surgery is not an option.
• General measures: Good hydration, normal dietary calcium, and avoiding thiazide diuretics and dehydration.

When it is urgent

Very high calcium causes severe thirst, vomiting, confusion, drowsiness and abnormal heart rhythm. This is a medical emergency needing intravenous fluids in hospital. After surgery, tingling around the lips or in the fingers, or muscle cramps, signal low calcium and need a blood test the same day.

Travelling to Türkiye for treatment

Parathyroid surgery is well suited to a short planned visit: localisation scans and the operation can be completed within about a week, with a single night in hospital. Surgeon volume matters greatly here, so ask how many parathyroid operations the surgeon performs a year. Calcium and PTH should be rechecked at home at two weeks and six months. If your scans have been negative at home, that does not rule out surgery, but it calls for an especially experienced team.

Send your reports, scans and a short history and a Clinic-Y coordinator replies within 24 hours with suitable teams and written, all-inclusive proposals side by side. Reviewing your case is free.

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