Hyperparathyroidism - Causes, Symptoms and Treatment

Hyperparathyroidism is the overproduction of parathyroid hormone (PTH) by the parathyroid glands. Four tiny endocrine glands, the parathyroid glands, can be found in the neck, close to or adjacent to the back of the thyroid. Endocrine glands secrete hormones required for the body's typical function. The hormone ensures that the bloodstream and tissues that need calcium to function are kept at an appropriate calcium level. The body's calcium levels might rise to high levels when these glands overproduce PTH. It may result from numerous health problems, including weak bones and kidney stones.

The thyroid glands create the parathyroid hormone, which aids in preserving the proper level of calcium in the blood and tissues that require calcium for proper function. It is particularly crucial for bone health and nerve and muscle function. There are three types of Hyperparathyroidism:

1. Primary hyperparathyroidism: It develops whenever there is a problem with at least one of the parathyroid glands. Benign growths on the gland and the enlargement of at least two glands are frequent causes of parathyroid issues.
2. Secondary hyperparathyroidism: An underlying disease that results in deficient calcium levels can lead to secondary hyperparathyroidism. Chronic renal failure, which causes low levels of vitamin D and calcium, is the leading cause of secondary hyperparathyroidism.
3. Tertiary hyperparathyroidism: It is a disorder that develops when the calcium levels are low due to an underlying illness.

Early hyperparathyroidism patients can not exhibit any symptoms. Minor symptoms accompany primary hyperparathyroidism problems. Milder symptoms could be:

1. Fatigue
2. Weakness
3. Depression
4. Body pain

More severe signs could be:

1. Decrease in appetite
2. Constipation
3. Vomiting
4. Nausea
5. Increased thirst resulting in more urine
6. Memory issues
7. Ureteral stones

The following symptoms are associated with secondary hypothyroidism:

This includes skeletal anomalies such as bone malformations, swelling joints, and fractures. The presence of additional symptoms depends on the underlying cause, which may be severe vitamin D insufficiency or chronic renal failure. 

The causes of Primary and Secondary Hyperparathyroidism are different. While the former results in the excessive production of calcium in the blood, the latter reduces calcium levels. 

Causes For Primary Hyperparathyroidism

1. A non-cancerous growth (adenoma) on one of the parathyroid glands is the most common cause of this condition.
2. The next most common cause is the enlargement of two or more glands, which leads to an excessive generation of PTH.
3. Parathyroid gland cancer.

Causes for Secondary Hyperparathyroidism

1. Excessively active parathyroid glands might result from reduced calcium absorption from meals following intestinal surgery.
2. The human body needs vitamin D to absorb calcium from meals. In addition, secondary hyperparathyroidism may occur from a deficiency of Vitamin D.
3. Vitamin D levels drop due to chronic kidney illness, which causes calcium insufficiency and excessive PTH generation. 

The risk factors for hypoparathyroidism include recent thyroid or neck surgery, a family history of parathyroid dysfunction, and specific autoimmune endocrine conditions such as Addison's disease. The following are typical risk factors for the onset of primary hyperparathyroidism:

1. Postmenopausal females
2. 50 to 60 years old
3. Having a family history of thyroid problems

Secondary hyperparathyroidism is frequently associated with the following risk factors:

1. High levels of serum phosphorus 
2. Low levels of serum creatinine
3. Low levels of serum calcium
4. Females with High Blood Pressure

Tertiary hyperparathyroidism is frequently associated with the following risk factors:

1. People in their 80s
2. Longer dialysis sessions

If there are no symptoms and only a slight increase in blood calcium levels, the doctor may decide against treating mild hyperparathyroidism right away. Six months following each of these tests, he will evaluate calcium levels in the blood, blood pressure, renal function, and bone density in its place (every one to three years). However, you can reduce the risk of hyperparathyroidism by undertaking the following measures:

1. Consumption of calcium supplements dramatically reduces the development of hyperparathyroidism. But patients must take care not to take too much calcium, which can cause other health issues. 
2. Vitamin D supplements can help to prevent the worsening of the condition. Various food items provide a good quantity of this vitamin. But one must maintain optimum levels as high amounts can be toxic.
3. Ensuring the intake of a good quantity of fluids also helps slow the disease's progress. 
4. Regular exercise and weight loss can help those suffering from hyperparathyroidism. 

In almost all cases, the diagnosis of the condition is through blood tests conducted for other diseases. In many cases, the symptoms can be very mild or even non-existent. 

1. Blood analysis shows an increased level of calcium.
2. A repeat blood test after fasting shows the same result.
3. The doctor can confirm the disease if there is a high parathyroid hormone level. 

Another set of tests is conducted to reconfirm the occurrence of the disease.

1. Specialists conduct a bone mineral density test. In this test, special x-ray machines will assess how much calcium is present in a bone segment. 
2. The amount of calcium being passed out can be identified by a 24-hour urine test. It will confirm if there is a kidney disorder that is causing hyperparathyroidism. A low amount of calcium in urine means that everything is fine. 
3. An X-ray or ultrasound scan of the abdomen helps doctors know whether there are kidney stones or other kidney problems. 
4. In addition, the doctor checks the medical history of the patient to know if any hereditary factors are likely to cause Hyperparathyroidism.

How to prepare for the doctor’s consultation?

In most cases, the mild form of Hyperparathyroidism is detected when a regular blood test is done for other illnesses or as part of a health check-up. So, the first visit to the doctor would be with the test results. Here are the questions that the doctors will ask:

1. Doctors will enquire whether the patient:
2. Has been feeling depressed lately
3. Is feeling tired, exhausted or ill
4. Has any unexplained pain or ache?
5. Experiences forgetfulness, absent-mindedness or difficulty concentrating.
6. Feeling excessively thirsty and a need to urinate more often.
7. Are they taking any medicines regularly?
8. Consumes a diet that provides adequate calcium and Vitamin D.

Patients Must Ask The Following Questions To The Doctor

1. What tests must be done to find out the cause?
2. Should the patient see a hormone specialist?
3. Is surgery recommended, or are there any other forms of treatment?
4. How can they manage the health conditions resulting from the disease?

As the severity and conditions of hyperparathyroidism can differ from one patient to the next, doctors use different treatment methods.

Hyperparathyroidism treatment without surgery

1. A Wait And Watch Approach
   1. Doctors use this approach with regular tests conducted every six months. They will not treat the patient if after six months:
   2. The calcium levels are only a little higher than usual.
   3. There are no kidney stones, and the kidneys are working well. Doctors check this as this is one of the symptoms of hyperparathyroidism.
   4. Bone density is only slightly lower or within the standard range.
   5. There are no other symptoms that require treatment.
   6. In such cases, regularly scheduled blood tests are conducted to assess blood calcium levels and bone density. Doctors also advise measures to make sure that the condition doesn't worsen.
   7. Monitor the amount of calcium and vitamin D the patient gets through food. People of different ages and genders need different quantities of these nutrients. The specialists will advise patients about this and suggest special diets.
   8. Drinking a lot of fluids, especially water, prevents the formation of kidney stones. 
   9. Regular exercises, including strengthening activities, can help get strong bones. Patients can find out from experts what exercise is best suited for them.
   10. Quitting smoking is highly recommended as the habit can increase bone loss and cause other health problems.
   11. Patients taking medication that raises calcium levels must talk to the doctor and seek alternate medicines. 
        
2. Treatment of primary hyperparathyroidism with medicines
   1. Calcimimetics - These drugs mimic calcium levels in the blood, regulating the hormones released by the parathyroid glands. These medicines are ideal for patients with primary hyperparathyroidism who cannot be operated on. Possible side effects of this medicine are joint and muscle pain, diarrhoea, nausea and respiratory infection.
       
3. Treatment Of secondary hyperparathyroidism with medicines
   1. Vitamin D Supplements:These medicines, combined with Calcimimetics, are generally used to treat secondary hyperparathyroidism. It helps keep the balance of calcium and phosphorus minerals in the body, thus preventing the need for the parathyroid glands to work hard. 
   2. Hormone Replacement Therapy: This treatment is suitable for women who have gone through menopause. It will help maintain calcium levels in the bones. However, long-term use of such medicines increases the chances of blood clots and breast cancer. Side-effects like breast pain, tenderness, dizziness and headache can also occur. This medication doesn't take care of the underlying issues with the parathyroid glands. 
   3. Bisphosphonates: These medicines only address hyperparathyroidism's effects by helping the bones retain calcium. The fundamental problems with the glands don't get cured with such medication. Low blood pressure, fever and vomiting are the possible side effects of these medicines. 

Hyperparathyroidism treatment with surgery 

1. The standard treatment recommended for Primary Hyperparathyroidism is Parathyroidectomy surgery. 
2. Only the affected parathyroid glands are removed in this procedure.
3. If all four glands are affected, doctors will remove three glands and take out a portion of the fourth gland. It allows some functioning tissue to be left behind. 
4. The surgery is done through small incisions after administering general anaesthesia.
5. It is an outpatient procedure allowing patients to go home the same day.
6. In almost all cases, patients get a complete cure with this operation. 
7. The surgery costs range from INR 40,000 to 55,000, depending on the city and hospital chosen.
8. Complications with the removal of parathyroid glands are not very common.
9. Risks include damage to the nerves controlling the vocal cords. 
10. Patients may also suffer from long-term low calcium levels in the body.  It can treat with calcium and Vitamin D supplements. 

The consequences of not treating the disease on time can be severe. The complications result from having too little calcium in the bones and too much calcium in the blood.

1. Osteoporosis - It is a condition where the bones are fragile and brittle. They tend to break very easily. It results from a deficiency of calcium in the bones. 
2. Kidney Stones - Excess calcium in the blood leads to increased minerals in the person's urine. It causes calcium deposits and other substances to form in the kidneys, more popularly known as kidney stones. It can be a painful condition. 
3. Cardiovascular Diseases -High calcium levels in the blood are known to affect the heart and blood vessels adversely. The person can suffer from high blood pressure and other heart conditions. 
4. Neonatal Hyperparathyroidism - Primary hyperparathyroidism can occur in pregnant ladies, which is rare. If left untreated, newborns can have dangerously low calcium levels.

When Does A Person Need To Consult A Doctor?

When a person sees the symptoms mentioned above, it is better to consult a specialist. There could be dangerous consequences that may have symptoms due to various conditions. Though the signs are common to other illnesses, it is better to check with a surgeon and ensure that you don't have hyperparathyroidism. Getting timely treatment can result in controlling the disease efficiently.

A good diet is crucial since what we eat affects our health. It is advised to follow the advice of a doctor or a dietician and adjust the food plan for hyperparathyroidism.

1. Beans, almonds and leafy, dark-green vegetables are all excellent sources of calcium that support the development of strong bones.
2. Lean meat, such as fish, is preferable to red meat regarding general health. Tofu and beans are also excellent non-meat sources of protein.
3. Trans-fatty acids, frequently present in processed foods like cookies and baked goods, should be avoided.
4. To get more fibre and prevent constipation, use whole grain goods like bread and pasta rather than refined ones like white bread.