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Hyperparathyroidism

Also listed as: Parathyroid - overactive

Signs and Symptoms
What Causes It?
Who's Most At Risk?
What to Expect at Your Provider's Office
 
Treatment Options
Prognosis/Possible Complications
Following Up
Supporting Research

Hyperparathyroidism is a condition in which the parathyroid glands, located in the neck, secrete too much parathyroid hormone (PTH). Parathyroid hormone regulates the amount of calcium and phosphorus (minerals necessary for strong bones and teeth) in the body, by controlling how much calcium is taken from bones, absorbed in the intestines, and lost in urine. When too much parathyroid hormone is secreted, levels of calcium in the blood and urine rise, and bones may lose calcium, leading to osteoporosis.

Signs and Symptoms

In about half of the cases of primary hyperparathyroidism, the patient has either vague symptoms or no symptoms at all. The condition is often diagnosed through routine blood tests that show high levels of calcium. When symptoms do occur, they are generally due to persistently high levels of calcium and may include:

  • Joint pain
  • Bone loss leading to osteoporosis
  • Muscle weakness
  • Abdominal discomfort
  • Nausea and vomiting
  • Constipation
  • Lack of appetite
  • Kidney stones
  • Excessive thirst
  • Excessive urination
  • Anxiety
  • Memory loss
  • Fatigue

What Causes It?

In most cases, the cause of hyperparathyroidism is not known. It may develop as a result of one of the following conditions:

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

Who's Most At Risk?

The following conditions or characteristics put you at higher risk for developing primary hyperparathyroidism:

  • Age: risk increases as you get older, reaching a peak between 50 and 60 years (but the disease can also affect children).
  • Gender: twice as many women as men have the condition.
  • Inherited endocrine problems (MEN syndromes)
  • Previous neck irradiation

What to Expect at Your Provider's Office

Hyperparathyroidism is diagnosed through blood tests that show high levels of calcium and parathyroid hormone. About half the time, health care providers discover primary hyperparathyroidism from a routine blood test. If your doctor suspects primary hyperparathyroidism, the doctor will do a physical examination and ask about symptoms of abdominal pain and constipation, depression, anxiety, memory loss, muscle weakness, and urinary problems. The health care provider may take a sample of your urine to test to check for kidney problems caused by excess calcium, and have you take a bone density scan to check bone health. An ultrasound of the neck may be performed to see 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 is no known way to prevent primary hyperparathyroidism. However, people who are at risk should avoid dehydration.

Treatment Plan

Surgery to remove one or more of the parathyroid glands is very successful in treating primary hyperparathyroidism. Sometimes, if a person does not show any signs or symptoms of the disease and has only mildly elevated calcium levels, they may not need immediate treatment -- but they will need to be monitored (for calcium blood levels and bone density) to watch for any changes in their condition.

Drug Therapies

Surgery is the primary treatment. However, under certain circumstances, the following medications may be used:

  • A specific type of diuretic, along with intravenous fluids, can be used to lower levels of calcium in the blood while the person is awaiting surgery.
  • Calcitonin may be given by injection to build bone density.
  • Bisphosphonates, such as tiludronate and alendronate, may be used after surgery to lower calcium levels. However, they are not generally used long term.

Surgical and Other Procedures

Parathyroidectomy involves removal of one or more of the four parathyroid glands.

Complementary and Alternative Therapies

Hyperparathyroidism should never be treated by alternative medicine alone. Some CAM therapies may be supportive when used along with conventional treatment. Keep all of your health care providers informed about any CAM therapies you are considering using.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms of hyperparathyroidism. Do not take these supplements without your doctor's supervision:

  • Eliminate all potential food allergens, including dairy, wheat (gluten), soy, corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
  • Eat calcium rich foods, including beans, almonds, and dark green leafy vegetables (such as spinach and kale).
  • Avoid refined foods, such as white breads, pastas, and sugar.
  • Eat fewer red meats and more lean meats, cold water fish, tofu (soy), or beans for protein.
  • Use healthy cooking oils, such as olive oil or vegetable oil.
  • Reduce or eliminate trans-fatty acids, found in commercially baked goods such as cookies, crackers, cakes, and donuts. They are also found in French fries, onion rings, processed foods, and margarine.
  • Limit carbonated beverages. They are high in phosphates, which can leach calcium from your bones.
  • Avoid coffee and other stimulants, alcohol, and tobacco.
  • Drink 6 - 8 glasses of filtered water daily.
  • Drink soy milk, for bone health unless allergic to soy.
  • Exercise moderately at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

  • A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals, such as magnesium, calcium, zinc and selenium.
  • Calcium citrate, 500 - 1,000 mg daily, for bone support.
  • Vitamin D, 400 IU daily, for bone support and immunity.
  • Ipriflavone (soy isoflavones) standardized extract, 200 mg 3 times a day, for bone loss. Because hyperparathyroidism may lead to osteoporosis, taking ipriflavone may help treat this cause of bone loss. Ipriflavone can lower white blood cell counts and has the potential to interact with a variety of medications; speak with your physician.
  • Omega-3 fatty acids, such as fish oils, 1 - 2 capsules or 1 - 2 tablespoonfuls of oil daily, to help decrease inflammation and support healthy metabolism. Omega-3 fatty acids can have a blood thinning effect and may increase the effect of blood thinning medications, such as Coumadin (warfarin) and aspirin.
  • Foods rich in calcium include:
    • Almonds
    • Legumes
    • Dark leafy greens
    • Blackstrap molasses
    • Oats
    • Sardines
    • Tahini
    • Prunes
    • Apricots

Your doctor may recommend you take calcium with a glass of orange juice -- some forms of calcium are better absorbed in an acidic environment. You can also add acid to your diet by squeezing lemon juice over leafy greens.

Herbs

Herbs are generally available as standardized dried extracts (pills, capsules, or tablets), teas, or tinctures/liquid extracts (alcohol extraction, unless otherwise noted). Mix liquid extracts with favorite beverage. Dose for teas is 1 - 2 heaping teaspoonfuls/cup water steeped for 10 - 15 minutes (roots need longer).

No scientific research has studied the use of herbs to treat hyperparathyroidism. The following herbs are sometimes used to counter the bone loss that can occur from hyperparathyroidism. Talk to your health care provider before taking any herbs if you have hyperparathyroidism.

  • Chaste tree (Vitex agnus castus) standardized extract, 20 - 40 mg daily before breakfast, for support of the parathyroid gland. Chaste tree extract has many possible drug interactions; speak with your physician.
  • Dandelion (Taraxacum officinale) leaf tincture, 5 - 10 mL 2 - 3 times a day, for its high mineral content. You can also prepare teas from the leaf. Certain drugs can interact with Dandelion, including lithium and some antibiotics; speak with your physician. People with Ragweed allergies may also have an allergic reaction to Dandelion.

Homeopathy

Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of hyperparathyroidism based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

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

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, with cure rates of 94 - 96%. 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. Various cardiovascular conditions are also associated with hyperparathyroidism.

Following Up

If you have surgery, your doctor will check your blood calcium levels for several months to be sure that the levels remain stable. If you do not have surgery, your calcium levels will need to be checked over a longer period of time, and your checkups will include a careful assessment of your bones and kidneys.

Supporting Research

Abdelhadi M, Nordenstrom J. Bone mineral recovery after parathyroidectomy in patients with primary and renal hyperparathyroidism. J Clin Endocrinol Metab. 1998;83(11):3845-3851.

Adler JT, Sippel RS, Schaefer S, Chen H. Surgery improves quality of life in patients with "mild" hyperparathyroidism. Am J Surg. 2009;197(3):284-90.

Alexandersen P, Toussaint A, Christiansen C, et al. Ipriflavone in the treatment of postmenopausal osteoporosis: a randomized controlled trial. JAMA. 2001;285:1482-8.

Beers MH, Porter RS, et al. The Merck Manual of Diagnosis and Therapy. 18th ed. Whitehouse Station, NJ: Merck Research Laboratories; 2006:1254-1255, 1256, 1258-1259.

Chertok-Shacham E, Ishay A, Lavi I, Luboshitzky R. Biomarkers of hypercoagulability and inflammation in primary hyperparathyroidism. Med Sci Monit. 2008;14(12):CR628-32.

Fauci A , Kasper D, Longo DL, et al, eds. Harrison's Principals of Internal Medicine. 17th ed. [online version]. New York, NY: McGraw Hill; 2008.

Felger E, Kandil E. Primary Hyperparathyroidism. Otolaryngologic Clinics of North America. 2010;43(2).

Ferri: Ferri's Clinical Advisor 2011, 1st ed. St. Louis, MO: Mosby. 2010.

Head KA. Ipriflavone: an important bone-building isoflavone. Altern Med Rev. 1999;4(1):10-22.

Jorde R, Szumlas K, Haug E, Sundsfjord J. The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake. Eur J Nutr. 2002 Dec;41(6):258-63.

Lydeking-Olsen E, Beck-Jensen JE, Setchell KD, Holm-Jensen T. Soymilk or progesterone for prevention of bone loss -- a 2 year randomized, placebo-controlled trial. Eur J Nutr. 2004;43(4):246-57.

NIH Osteoporosis and Related Bone Diseases National Resource Center. Information for Patients about Primary Hyperparathyroidism. National Institutes of Health.

Wuttke W, Jarry H, Christoffel V, Spengler B, Seidlove-Wuttke D. Chaste tree (Vitex agnus-castus) -- pharmacology and clinical indications. Phytomedicine. 2003;10(4):348-57.


Review Date: 10/12/2010
Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.
The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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