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Am Fam Physician. 1998;57(8):1807-1808

See related article on hyperparathyroidism.

What is hyperparathyroidism?

When the parathyroid glands make too much hormone, it's called hyperparathyroidism (HPT for short). The parathyroids are four glands behind the thyroid gland at the front of your neck. The hormone they make is called parathyroid hormone (or PTH). This hormone keeps the right level of calcium in your blood and bones. It helps you absorb calcium from your food and helps you lose less calcium in urine.

The amount of calcium going into your bones usually matches the amount of calcium coming out of your bones. This means that the amount of calcium in your bones should stay about the same all the time. If you have HPT, you have too much calcium in your blood. (More calcium is being taken out of your bones than is being put back.) Having too much calcium in your blood also means that other parts of your body don't work right. HPT is usually caused by a noncancerous growth in one of the parathyroid glands. These growths are too small for you to feel.

What does HPT do to your body?

If you have HPT, you may notice that you feel different. You might get depressed (feel down) or feel tired all the time. Any part of your body might hurt. You might have heartburn because the high calcium level in your blood causes your stomach to make too much acid. You might have nausea, vomiting, pain in your abdomen (tummy) or constipation. Your bones might hurt if they don't have enough calcium in them. Losing calcium also makes your bones weak. Weakened bone breaks more easily and is slower to heal than normal bone.

You might develop kidney stones, because your kidneys try to filter out the extra calcium in your blood. Too much calcium in your kidneys might make you thirsty or increase your need to urinate. Too much calcium in your blood also causes high blood pressure. All these things happen so slowly that you may not notice at first, or you may think it's normal to feel bad.

Who gets HPT?

More women get HPT than men. HPT is more common in older people. Nothing you eat or do causes this disease. You have about one chance in 1,000 of getting this disease after you are 60 years old.

How does my doctor know I have HPT?

HPT is most often suspected when a high level of calcium is found in your blood on a routine blood test. The test results can help your family doctor make the diagnosis even before the problems start. This is one benefit of having regular blood tests. Further blood testing proves the diagnosis, usually by measuring the amount of PTH in your blood. A special scan can find the growth. Regular x-rays look normal until late in the disease, so they aren't much help in diagnosing HPT. Other causes of increased calcium in the blood, such as some medicines or cancer, must sometimes be considered.

How is HPT treated?

Surgery almost always solves the problem by removing the growth in your neck. The growth doesn't usually come back. Most of your symptoms will stop in the first month after surgery. For a short time after surgery, your blood calcium level may be too low. This problem is easily treated with medicine. Although surgery is usually recommended for people with HPT unless they have no symptoms, sometimes medical problems make surgery too risky. Then treatment with medicine alone is advised. Medicines can treat some, but not all, of the symptoms of HPT. If you don't have surgery, tests are needed from time to time to see if the disease is hurting your kidneys, bones or other body systems. Special machines can check your bone strength. If you take estrogen after menopause, you're partly protected from the effects of HPT.

If you're like most people, you'll feel much better after treatment. The discomforts that you've been trying to live with go away.

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