Hyperparathyroidism

There are four parathyroid glands, located behind the two lobes of the thyroid gland. The parathyroid glands produce the hormone that regulates blood levels of calcium and phosphate, minerals necessary for strong bones and teeth. Primary hyperparathyroidism is characterized by an overproduction of parathyroid hormone, which, in turn, results in an elevation of calcium levels in the blood.

Signs and Symptoms

At least 50% of patients with primary hyperparathyroidism have no symptoms, and approximately 1% of cases go undiagnosed. When symptoms do occur, they are generally attributable to persistently high levels of calcium and may include:

• Joint pain
• Bone loss leading to osteoporosis
• Muscle weakness
• Abdominal discomfort
• Heartburn
• Nausea and vomiting
• Constipation
• Lack of appetite
• Ulcers
• Pancreatitis (inflammation of the pancreas)
• Kidney stones
• Excessive thirst
• Excessive urination
• Depression
• Anxiety
• Memory loss
• Excessive drowsiness

What Causes It?

Primary hyperparathyroidism may develop as a result of one of the following conditions:

• Single or multiple benign tumors in the parathyroid glands
• Parathyroid hyperplasia (excessive growth of normal parathyroid cells)
• Parathyroid malignancies (rare)
• Certain endocrine disorders, such as Type I and II multiple endocrine neoplasia (MEN) syndromes

Who's Most At Risk?

People with the following conditions or characteristics are at risk for developing primary hyperparathyroidism:

• Age: incidence increases with age (but the disease can also affect children)
• Gender: affects twice as many women as men
• Genetic endocrine problems (MEN syndromes)

What to Expect at Your Provider's Office

The diagnosis of primary hyperparathyroidism is made mostly on the basis of lab tests that show high levels of calcium and parathyroid hormone. About half the time, healthcare providers discover primary hyperparathyroidism inadvertently from a blood test drawn for other reasons. Once a provider suspects that a person has primary hyperparathyroidism, he or she will do a physical examination and will ask about symptoms of abdominal pain and constipation, depression, anxiety, memory loss, muscle weakness, and urinary problems. Urine is often collected to check for excess calcium. Imaging may be done to assess any bone loss. An ultrasound of the neck may be performed to determine if the parathyroid glands are enlarged. A computed tomography (CT) scan or magnetic resonance imaging (MRI) may be used to check for a tumor.

Treatment Options

Prevention

There are no known preventive measures for primary hyperparathyroidism; however, it may be prudent for people who are at risk to avoid dehydration.

Treatment Plan

Surgery to remove one or more of the parathyroid glands is very successful in treating primary hyperparathyroidism. Because of this, surgery is usually recommended. In rare cases, if a patient does not show any signs or symptoms of the disease and has only mildly elevated calcium levels, the medical specialist may be willing to wait, observe carefully over time, and consider the nonsurgical approach of medications to prevent or treat complications and/or a further rise in calcium levels.

Drug Therapies

Surgery is the treatment of choice; however, under certain circumstances, the following medications for primary hyperparathyroidism may be considered:

• A specific class of diuretics, along with intravenous hydration, is used in the acute phase to lower levels of calcium in the blood while the person is awaiting surgery.
• Calcitonin may be used in injectable form.
• Estrogen may preserve bone mass and reduce calcium levels in postmenopausal women who are not able to undergo surgery.
• Bisphosphonates, such as tiludronate and alendronate, may be used after surgery.

Surgical and Other Procedures

Parathyroidectomy involves removal of one or more parathyroid glands.

Complementary and Alternative Therapies

Nutrition

• Ipriflavone is an isoflavone, or estrogen-like compound from plants, found mainly in soy and also available in supplement form. Several scientific studies have investigated the effect of ipriflavone on patients with osteoporosis. Some studies suggest that ipriflavone may stop bone loss and help new bone form. Because hyperparathyroidism may lead to osteoporosis, the question has been raised about the possible use of ipriflavone to treat this cause of bone loss. One study found that ipriflavone helped reduce loss of bone but did not stimulate formation of new bone. Given that this study had only nine people, more research is needed to fully determine the value of using ipriflavone in people with hyperparathyroidism.

A person with primary hyperparathyroidism who also has borderline nutritional status may develop deficiencies in the following substances that are necessary for normal bone formation:

• Vitamin C
• Vitamin K
• Manganese

In these cases, the healthcare provider may recommend that the person take particular nutritional supplements.

Herbs
A naturopathic doctor or other appropriately trained practitioner may consider the following medicinal herbs to treat or prevent bone abnormalities related to hyperparathyroidism. Before using these herbs, however, it is best to obtain guidance and advice from such a practitioner:

• Black cohosh (Cimicifuga racemosa) is reported to have estrogen-like effects and may enhance estrogen's role in the body, such as reducing the breakdown of bone; more research is needed to determine the value of this use.
• Ginkgo biloba extract contains substances similar to isoflavone in soy (see Nutrition section), raising the theoretical possibility that this herb may also have some degree of bone protection; studies regarding this potential use have not been conducted to date.
• Horsetail (Equisetum arvense) is rich in minerals and has been used in traditional remedies to support normal bone integrity.
• Oat straw (Avena sativa) is rich in minerals and has been used in traditional remedies to support normal bone integrity.

Homeopathy
A qualified homeopath would do a clinical assessment and guide treatment appropriately.

A homeopathic doctor may use one of the following to treat problems related to calcium levels:

• Calcarea carbonica (calcium carbonate)
• Calcarea phosphorica (calcium phosphate)

To date the use of these substances for hyperparathyroidism has not been examined in scientific studies.

Prognosis/Possible Complications

The prognosis is excellent for persons with primary hyperparathyroidism who have no symptoms, as well as those who have surgery to remove one or more parathyroid glands. Possible complications include skeletal damage, urinary tract infections, kidney damage or kidney stones, peptic ulcers, inflammation of the pancreas, high blood pressure, nervous system disorders, and rare complications from surgery.

Following Up

People who have had surgery will have their blood calcium levels monitored for several months afterward to be sure that the levels remain stable. The healthcare provider will check blood calcium levels for a longer period of time if a person does not have surgery. In this case, the person will have regular checkups that will include a careful assessment of the bones and kidneys.

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