Parathyroid Disease (Hyperparathyroidism)

The four parathyroid glands sit behind the thyroid and control calcium in the blood through parathyroid hormone (PTH). In primary hyperparathyroidism one or more glands become overactive, nearly always because of a benign growth called an adenoma, and blood calcium rises.

It is common, especially in women after the menopause, and is often picked up on a routine blood test. Over years the excess hormone thins the bones and promotes kidney stones. Surgery cures most people. Mild cases can be monitored safely.

Symptoms

• Often no symptoms, found on a blood test
• Tiredness, low mood and poor concentration
• Thirst and passing urine often
• Kidney stones
• Bone and joint aches or fractures from fragile bones
• Constipation, nausea or abdominal pain
• Muscle weakness

Causes and risk factors

In about 85 percent of people a single benign adenoma is responsible. The remainder have enlargement of several glands or, very rarely, parathyroid cancer. Most cases are sporadic. Younger patients and those with affected relatives may have an inherited syndrome such as MEN1 or MEN2A. Long-term lithium treatment and earlier neck irradiation raise the risk. Secondary hyperparathyroidism is a different situation in which the glands react to low calcium or vitamin D, most often in chronic kidney disease. Low parathyroid function usually follows neck surgery and causes low calcium.

How it is diagnosed

• Blood calcium with PTH: Raised calcium with a PTH that is high or not suppressed makes the diagnosis.
• Vitamin D, kidney function and 24-hour urine calcium: Separate the condition from vitamin D deficiency and from a harmless inherited trait called familial hypocalciuric hypercalcaemia.
• Bone density scan: Includes the forearm, which is affected early.
• Kidney ultrasound or CT: Looks for silent stones.
• Localisation imaging: Neck ultrasound and sestamibi scan, or 4D-CT or choline PET. These are for planning surgery, not for making the diagnosis.

Treatment options

• Parathyroidectomy: Removal of the overactive gland, usually through a small incision as a day case or with one night in hospital. It is advised for symptoms, calcium clearly above normal, osteoporosis, kidney stones or reduced kidney function, or age under 50.
• Monitoring: Yearly calcium and kidney tests, with bone density every 1 to 2 years, for mild disease with none of those features.
• Cinacalcet: Lowers calcium when surgery is not possible. It does not protect bone.
• Bone-protecting medicines: Bisphosphonates or denosumab for osteoporosis where surgery is not done.
• General measures: Drink enough water, keep dietary calcium normal, correct vitamin D carefully and avoid thiazide diuretics.

When it is urgent

Very high calcium can cause severe thirst, vomiting, confusion, drowsiness and an irregular heartbeat. This needs emergency care locally for fluids and medicines. After surgery, tingling around the lips or in the fingers or muscle cramps suggest low calcium and need a same-day blood test.

Travelling to Türkiye for treatment

Parathyroid surgery is short and planned and has high cure rates when done by surgeons who perform many, so it suits travel well. Allow 5 to 7 days including imaging, the operation and a calcium check. Confirm the biochemistry at home first, since imaging alone does not prove the disease. You will need calcium measured in the weeks after your return and again at 6 months to confirm cure.

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.

Frequently Asked Questions