Hyperparathyroidism

Diagnosis

Hyperparathyroidism is often discovered during routine blood tests when a high level of calcium is detected. If your healthcare provider suspects hyperparathyroidism, several tests can help confirm the diagnosis and assess its effects on your body.

Blood tests
When a blood test shows a high calcium level, it’s usually repeated for confirmation. Hyperparathyroidism is diagnosed when both calcium and parathyroid hormone (PTH) levels are elevated at the same time. Other conditions can also raise calcium levels, so additional testing helps confirm the cause.

More testing
Once hyperparathyroidism is diagnosed, further tests help determine the severity of the condition and whether it is causing other health issues. These may include:

• Bone mineral density test: A dual-energy X-ray absorptiometry (DXA) scan measures bone mineral density to check for osteoporosis or bone weakening.

• Urine test: A 24-hour urine collection assesses kidney function and calcium levels in urine. This test helps evaluate disease severity and detect kidney-related causes.

• Imaging tests of the kidneys: X-rays, ultrasounds, or other scans can reveal kidney stones or other kidney conditions linked to hyperparathyroidism.

Imaging tests before surgery
If surgery is needed, imaging helps locate overactive parathyroid glands. Common options include:

• Sestamibi parathyroid scan: This test uses a radioactive tracer that highlights parathyroid glands producing too much hormone. Radioactive iodine may also be used to distinguish the thyroid from the parathyroid glands. Sometimes, CT scanning is combined with the sestamibi scan for a clearer view.

• Ultrasound: High-frequency sound waves create images of the parathyroid glands and nearby tissues. This noninvasive test helps identify enlarged or abnormal glands before surgery.

Treatment

Treatment for hyperparathyroidism depends on the severity of the condition, symptoms, and overall health. Options include watchful waiting, surgery, and medications.

Watchful waiting
For mild cases of primary hyperparathyroidism, a healthcare provider may recommend regular monitoring instead of immediate treatment. Watchful waiting may be appropriate if:

• Calcium levels are only slightly elevated

• Kidney function is normal and no kidney stones are present

• Bone density is within or close to the normal range

• There are no significant symptoms that require intervention

During watchful waiting, periodic blood tests, bone density scans, and kidney function tests are performed to monitor changes over time.

Surgery
Surgery is the most effective treatment for primary hyperparathyroidism and often provides a permanent cure. The surgeon removes any enlarged or tumor-affected parathyroid glands.

• If all four glands are affected, typically three and part of the fourth are removed to preserve some parathyroid function.

• The procedure is often done as an outpatient surgery using small incisions and local anesthesia.

Complications are uncommon but can include:

• Nerve damage affecting the vocal cords

• Low calcium levels if all parathyroid glands are removed or damaged, leading to hypocalcemia

Medicines
Medication may be used when surgery isn’t possible or doesn’t fully correct the condition. Options include:

• Calcimimetic (cinacalcet): Mimics calcium in the blood, reducing PTH production. It’s used for people who can’t undergo surgery or have persistent hyperparathyroidism after surgery. It can also be prescribed with vitamin D for those with kidney-related secondary hyperparathyroidism.

• Bisphosphonates: Help prevent calcium loss from bones and manage osteoporosis caused by hyperparathyroidism, though they don’t lower calcium levels in the blood.

• Hormone replacement therapy: For postmenopausal individuals with osteoporosis, hormone therapy can help maintain calcium in bones but doesn’t treat the parathyroid disorder itself.

Early diagnosis and appropriate management of hyperparathyroidism can help protect bone health, prevent kidney stones, and improve long-term outcomes.