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
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:
Bone loss leading to osteoporosis
Nausea and vomiting
Lack of appetite
Pancreatitis (inflammation of the pancreas)
What Causes It?
Primary hyperparathyroidism may develop as a result of one of the following
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
Gender: affects twice as many women as men
Genetic endocrine problems (MEN
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.
There are no known preventive measures for primary hyperparathyroidism;
however, it may be prudent for people who are at risk to avoid dehydration.
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.
Surgery is the treatment of choice; however, under certain circumstances, the
following medications for primary hyperparathyroidism may be
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
Surgical and Other Procedures
Parathyroidectomy involves removal of one or more parathyroid glands.
Complementary and Alternative
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:
In these cases, the healthcare provider may recommend that the person take
particular nutritional supplements.
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.
A qualified homeopath would do a clinical assessment and guide treatment
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.
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.
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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Review Date: December 2000
Reviewed By: Participants in the review process include: Richard Glickman-Simon, MD,
Department of Family Medicine, New England Medical Center, Tufts University,
Boston, MA; Jacqueline A. Hart, MD, Department of Internal Medicine,
Newton-Wellesley Hospital, Harvard University and Senior Medical Editor
Integrative Medicine, Boston, MA; Leonard Wisneski, MD, FACP, George Washington
University, Rockville, MD.
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