The term hyperparathyroidism describes parathyroid hyperfunction. This means that in the affected person, the parathyroid gland produces an excessive amount of the parathyroid hormone.
What is hyperparathyroidism?
Hyperparathyroidism (parathyroid hyperfunction) is overactivity of the parathyroid gland so that too much of the parathyroid hormone is produced. This hormone is responsible for regulating phosphate and calcium balance in the body. If the organism has a high level of the parathyroid hormone, the calcium level in the blood increases. Many of the patients do not experience any symptoms, so that hyperparathyroidism is usually discovered by the doctor only by chance. However, some sufferers may experience symptoms that include gastrointestinal complications, muscle weakness, loss of appetite and high blood pressure. Women are diagnosed with hyperparathyroidism significantly more often than men. About two-thirds of all those affected are of the female sex. The disease can occur at any age. However, hyperparathyroidism occurs primarily after the age of 40.
Causes
There are different causes of hyperparathyroidism. Primary hyperparathyroidism develops when diseases of the parathyroid gland itself are the cause. However, if other diseases are responsible for the hyperparathyroidism, it is called secondary hyperparathyroidism. In general, the most common causes of this condition are diseases of the parathyroid gland. In most cases, benign tumors in the parathyroid gland, which produce hormones, are found in the affected person. These include parathyroid adenomas in particular. Secondary hyperparathyroidism is usually caused by diseases that lower the calcium level in the bloodstream. This may be, for example, a reduced calcium intake due to an unbalanced food intake, or a deficiency of vitamin D. In contrast to the primary form of hyperparathyroidism (parathyroid hyperfunction), the calcium level in secondary hyperparathyroidism is lower and not elevated.
Symptoms, complaints, and signs
In many cases, an elevated calcium level is detected during a routine blood test, providing an initial indication of the presence of hyperparathyroidism. Complaints do not yet occur in this so-called asymptomatic parathyroid hyperfunction. If the hormonal disorder remains undetected, the excess calcium in the blood can become noticeable through a series of symptoms: The first noticeable signs of hyperparathyroidism may be severe thirst and increased urine output, often accompanied by loss of appetite, nausea, vomiting, constipation and weight loss. High blood pressure, cardiac arrhythmias and chronic fatigue are also occasionally due to elevated calcium levels. Many affected individuals suffer from kidney stones, which can subsequently cause very painful renal colic. Recurrent urinary tract infections accompanied by back pain and pain in the upper abdomen must also be considered as kidney stone disease. As the disease progresses, bone metabolism is often affected: Affected individuals report joint and bone pain that is often misinterpreted as rheumatic complaints. An X-ray shows changes in the sense of osteoporosis (bone loss), with the risk of bone fracture even at low levels of stress. Calcification of blood vessels and muscles due to the increased calcium and phosphate concentration in the blood is also possible. Rarely, affected individuals develop psychiatric disorders such as depression, psychosis, or dementia as part of hyperparathyroidism.
Diagnosis and course
Examination of the thyroid glands. Primary hyperparathyroidism often shows no symptoms in the affected person, so the disease is often discovered only by chance during a blood test. For example, the concentration of calcium is usually significantly elevated in the blood. However, even in the primary form of this disorder, there does not have to be an increase in the calcium level. For example, a simultaneous deficiency of vitamin D or renal insufficiency can ensure regulation of the calcium level, although hyperparathyroidism is present.To determine the cause of hyperparathyroidism, doctors use various imaging techniques. These include ultrasound examination and scintigraphy. In some cases, cross-sectional imaging techniques are also used, which include magnetic resonance imaging (MRI) and computed tomography (CT). The course of the disease depends on the cause. The prognosis for primary hyperparathyroidism is good, provided surgical treatment is possible. Provided there are no other associated symptoms, the affected person is free of symptoms after surgery for his or her hyperparathyroidism.
Complications
Hyperparathyroidism causes a variety of symptoms. The affected person primarily suffers from nausea and vomiting. Furthermore, there is increased thirst and thus increased urination of the patient. Loss of appetite may also occur, resulting in underweight or deficiency symptoms. In the worst case, hyperparathyroidism leads to renal insufficiency. In this case, the affected person is then dependent on a kidney transplant or dialysis to continue to survive. Hyperparathyroidism often causes psychological distress and discomfort, so that psychological treatment is also necessary in most cases. The treatment of this disease is usually done by surgery, and there are no particular complications or other discomforts. The symptoms can be alleviated or even completely removed. Whether the life expectancy has been reduced by the disease depends largely on the severity and duration of hyperparathyroidism. In some cases, the disease leads to increased bone fragility. This can be prevented by treatment as well.
When should you see a doctor?
A visit to the doctor is necessary as soon as symptoms such as nausea, vomiting or dizziness develop. If there are abnormalities of the toilet, they must be observed. If they persist for several days, they should be examined more closely. If unusual bowel sounds, flatulence, digestive problems, constipation or diarrhea occur, a visit to the doctor is necessary. If the symptoms persist or increase in intensity, a doctor must be consulted. If there is a loss of appetite and a decrease in weight, a medical examination should be made. If the affected person suffers from frequent urination, this is a warning sign of the organism. Since it can lead to other diseases, a doctor should be consulted. If there are problems with the heart rhythm, changes in the usual performance or vegetative abnormalities, a visit to the doctor is necessary. In case of sweating, sleep disturbances, bone pain or swelling, a check-up visit should be made. If there are complaints in the spine or if there is pain in the limbs, it is advisable to consult a doctor. In case of emotional problems, mood swings, depressive behavioral traits or a loss of well-being, a doctor should be consulted. Irregularities of heart rhythm, high blood pressure or feeling of internal heat should be checked and investigated. Failure to seek medical attention may result in sudden bone fractures that require treatment.
Treatment and therapy
Treatment of hyperparathyroidism aims to regulate the level of calcium in the bloodstream. If primary hyperparathyroidism is present, surgery is one of the typical measures of therapy. In this surgical procedure, the physician removes the affected parathyroid gland or the designated epithelial bodies. If all four parathyroid glands are enlarged, the surgeon usually has to remove the entire organ. Subsequently, parts of the parathyroid gland are transplanted to another region in the body. Most often, this grafting is done into the muscles of the arm. In this way, a deficiency of hormones can be effectively prevented. If surgery is not possible or necessary as a treatment method for hyperparathyroidism, the physician resorts to a conservative therapy method. This includes, above all, sufficient fluid intake as well as a separate intake of vitamin D. For women who have already passed the time of menopause, a supply of biophosphonates can also be helpful. This prevents increased bone fragility.In some cases, therapy with the active ingredient cinacalcet is also necessary to relieve the patient of his or her symptoms. If secondary hyperparathyroidism (parathyroid hyperfunction) exists, the underlying disease is treated first and foremost.
Outlook and prognosis
The disease has a very favorable prognosis if diagnosed early. Often, no treatment is necessary. Monitoring of health functions is initiated and checked at regular intervals. In some cases, surgical intervention is performed. Since this is basically associated with risks, complications and sequelae may occur. This worsens the otherwise good prognosis. If the operation is successful, the patient is normally discharged from treatment as symptom-free. Nevertheless, regular check-ups are necessary in order to detect and treat possible disorders or changes at an early stage. In most cases, the patient’s living conditions do not have to be changed, as there are no adverse effects afterwards. If complications occur during the procedure, they must be individually evaluated and recorded. The further treatment plan depends on the damage or injuries that have occurred. A generally valid statement cannot be made. In the case of a severe course of the disease, kidney failure may occur. This course occurs only in exceptional cases, but has a life-threatening character. It is an acute condition that requires immediate intensive medical care. If the kidney’s inability to function cannot be adequately treated in time, the patient will die prematurely. If the patient survives, permanent impairment of renal function may occur, and further sequelae are possible.
Prevention
To date, no measures are known to prevent hyperparathyroidism. However, one protection against very serious complications in the primary form of hyperparathyroidism is surgical removal of the affected parathyroid gland.
Follow-up
In hyperparathyroidism, the method of follow-up depends on whether the condition was treated conservatively or by surgery. In both cases, close monitoring of health takes place to quickly detect any relapses. As part of conservative therapy and follow-up treatment, patients need to consume plenty of fluids and vitamin D. This can help alleviate the symptoms associated with parathyroid hyperfunction. Also helpful is frequent exposure to fresh air. Outdoors, sunlight stimulates the production of vitamin D. Following a detailed medical consultation, sufferers can take dietary supplements to support vitamin balance. However, patients should not take this additional vitamin D without consulting their doctor. This method can prevent or at least postpone secondary diseases such as osteoporosis. By means of a regular blood test, the doctor determines whether any adjustments are necessary for the health status or the balanced vitamin balance. Depending on the situation, nutritional counseling can help stabilize calcium levels. For patients, this means above all drinking plenty of fluids and eating dairy products and legumes only in small quantities. In self-help groups, they can talk about their problems and the recommended lifestyle changes.
Here’s what you can do yourself
Hyperparathyroidism is often accompanied by vitamin D deficiency. Therefore, sufferers benefit from spending time outdoors on a regular basis. Sunlight promotes the production of the vitamin. After consultation with the treating physician, dietary supplements also help to keep the vitamin balance in equilibrium. In this way, patients can prevent the development of late complications such as osteoporosis. It should be noted that regular blood tests must be carried out. In this way, it is always possible to respond directly to the current vitamin status. Nutritional counseling is also recommended. Since in most cases of hyperparathyroidism there is an elevated calcium level, a low calcium diet is advisable. This includes moderate consumption of dairy products and legumes. To increase calcium excretion, patients should also drink plenty of fluids.Here, a mineral water with a low calcium content should be selected. There are also self-help groups for people suffering from hyperparathyroidism. Here, those affected have the opportunity to exchange information. Such regular meetings with other patients often help people to cope better with the disease. A visit to an alternative practitioner is also often worthwhile. He or she recognizes regulatory disturbances of the vitamin balance and can contribute to a higher quality of life with natural methods. Also the accompanying symptoms such as fatigue are often treated with Schüssler salts, globules or herbal remedies.
