• Hyperparathyroidism is when the parathyroid glands secrete too much parathyroid hormone into the bloodstream. Parathyroid glands are located behind the thyroid and are about the size of a grain of rice
  • The parathyroid glands produce parathyroid hormone which helps maintain calcium balance in the bloodstream and in tissues
  • Two types of hyperparathyroidism exist- Primary and Secondary
  • In primary hyperparathyroidism, one or more of the parathyroid glands is enlarged and causes overproduction of the hormone. Surgery is the most common treatment for primary hyperparathyroidism
  • Secondary hyperparathyroidism occurs secondary to another disease that first causes low calcium levels in the body. Increased parathyroid hormone levels occur over time

Hyperparathyroidism is often diagnosed before apparent signs or symptoms occur. When symptoms do occur, they are a result of damage in other organs due to high calcium levels in the blood/urine or too little calcium in bones

Symptoms are usually mild and nonspecific. They include:

  • Osteoporosis
  • Kidney stones
  • Excessive urination
  • Abdominal pain
  • Tiring easily or weakness
  • Depression or forgetfulness
  • Bone and joint pain
  • Frequent complaints of illness with no apparent cause
  • Nausea, vomiting or loss of appetite
  • Pathological fractures

Primary hyperparathyroidism

  • A noncancerous growth (adenoma) of a parathyroid gland is the most common cause
  • Enlargement (hyperplasia) of two or more parathyroid glands
  • A cancerous tumor is a very rare cause

Secondary hyperparathyroidism

  • Severe calcium deficiency
  • Severe vitamin D deficiency
  • Chronic kidney failure

Complications of hyperparathyroidism are related to the long-term effects of too little calcium in the bones and too much calcium in the bloodstream. Common complications include:

  • Osteoporosis
  • Kidney stones
  • Cardiovascular diseases
  • Neuropsychiatric manifestations

1.    Biochemical confirmation

       Blood tests – High calcium, low phosphorous and raised parathyroid hormone levels


2.    Assess end organ damage

  • Bone mineral density test
  • Ultrasound abdomen
  • 24hour urinary calcium excretion

3.    Imaging tests before surgery to localize the enlarged parathyroid gland

  • Sestamibi parathyroid scan
  • High resolution ultrasonography of neck
  • 4-D Computed tomography


Surgery is the most common treatment for primary hyperparathyroidism and provides a permanent cure in most cases. Only those glands that are enlarged or have a tumor will be removed

If all four glands are affected, only three glands and a portion of the fourth gland are removed, leaving some functioning parathyroid tissue



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