The Parathyroids

Hyperparathyroidism means one or more of the four parathyroid glands in the neck make too much parathyroid hormone (PTH). PTH controls calcium levels in the blood and bones. Too much PTH causes high blood calcium (hypercalcaemia).

• Primary – a benign growth (adenoma) or, rarely, enlargement of several glands causes them to overproduce PTH.
• Secondary – low blood calcium (often from long‑term kidney disease or low vitamin D) makes the glands work harder.
• Tertiary – long‑standing secondary hyperparathyroidism leads the glands to stay overactive even after the original problem is fixed.
  

Primary hyperparathyroidism affects about 1–2 in 1,000 people, more often women over 50. Secondary hyperparathyroidism is common in people with chronic kidney disease.

• No symptoms – many cases are picked up on routine blood tests
• Tiredness and weakness
• Thirst and passing more urine
• Abdominal pain or indigestion
• Bone or joint aches
• Kidney stones
• Low mood or difficulty concentrating
  

• Kidney stones or kidney damage
• Osteoporosis (weakened bones) and fractures
• Pancreatitis
• High blood pressure and heart problems
  

Most commonly, a single benign adenoma on a parathyroid gland. Less often, enlargement of multiple glands or, rarely, cancer. Risk factors include female sex, age over 50, prior neck radiation, and certain genetic conditions.

• Blood tests – high calcium, high or inappropriately normal PTH, low phosphate
• Kidney function and vitamin D levels
• Bone density scan (DEXA) to assess bone strength
• Imaging scans (ultrasound, Sestamibi, or CT) to locate overactive gland(s) before surgery
  

• Surgery (parathyroidectomy) – the only cure for primary hyperparathyroidism; usually day‑case or overnight stay.
• Monitoring (‘watchful waiting’) – if calcium only slightly raised and no symptoms or complications.
• Medication – cinacalcet to lower calcium, vitamin D or calcium supplements for secondary hyperparathyroidism, phosphate binders in kidney disease.
• Treating the underlying cause – e.g. vitamin D replacement, optimising kidney disease management.
  

• Attend regular blood tests as advised (calcium, kidney function).
• Stay well‑hydrated (aim for 6–8 glasses of water daily).
• Maintain a balanced diet with adequate calcium unless told otherwise.
• Do weight‑bearing exercise to support bone health.
• Avoid smoking and limit alcohol.
  

• Sudden severe abdominal or flank pain (possible kidney stone).
• Confusion, muscle weakness, or vomiting (possible very high calcium).
• New bone pain or fracture.https://www.nhs.uk
  

• Your GP, endocrinologist, or kidney specialist
• Parathyroid UK – www.parathyroiduk.org
• NHS website – www.nhs.uk
• Kidney Care UK (for secondary hyperparathyroidism) – www.kidneycareuk.org