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Primary HPT

Primary hyperparathyroidism (pHPT) is the most common condition associated with the parathyroids. This disease is typically associated with high calcium levels. It is caused by one or more parathyroid tumors or parathyroid hyperplasia (enlargement of all four parathyroids).

During parathyroid surgery for primary hyperparathyroidism (high calcium preoperatively), I was found to have hyperplasia. My calcium is now normal but I have read that patients with hyperplasia have a higher chance of developing recurrent disease. What are the chances that I will get this again?

Parathyroid hyperplasia in primary hyperparathyroidism is interesting. Adenomas are straightforward: one "bad" gland is removed, and the normal ones are left behind to act normal. With hyperplasia, all four glands are involved, by definition. There are no completely normal glands. This is why we have to remove 3.5 glands, to debulk the parathyroids. In most cases, this produces a long-term cure...

Primary HPT Hyperplasia Secondary HPT Cure rate

My calcium is always noted to be “high-normal” but doctors are not concerned. Could I have parathyroid disease?

<p> It depends on what your actual calcium levels are. <strong>Sometimes what is called "high-normal" is actually too high. </strong> Adults over about age 40 will generally have calcium levels at or below 10.0 mg/dl (or 2.5 mmol/L). If it is persistently above that, then your calcium levels are high, not high-normal. (If you are under 40 years old, then you can have calcium levels that are sl...

Normal calcium Primary HPT Diagnosis

Why do you look at all four parathyroid glands during the operation? Doesn’t that pose a risk to the glands?

Seeing all four parathyroid glands is the best way to ensure that you are removing all of the diseased glands and leaving in normal ones. However, there can be a risk: when you look at all four parathyroid glands (or even attempt to look at all four parathyroid glands), you are creating scar tissue, which could then make future operations more difficult. There is even a risk that during the dis...

Operation Primary HPT Operative technique Cure rate

Is it safe to wait for surgery? I was diagnosed with primary hyperparathyroidism and told that I need surgery. Unfortunately I cannot get the operation done this month. Is it safe to delay the operation for a few months?

It is fine to delay. This is a disease that causes problems over decades. A delay of months, or even a year, is not likely going to cause any harm. You have likely had this growing for several years already before being diagnosed (this is true for most patients), so a little longer won't significantly harm you. While you are waiting for the operation, the best things to do are: stay hydrated...

Primary HPT Operation Treatment

I have had high calcium levels for over 30 years, but have never been diagnosed with parathyroid disease. I’ve never had any health problems. Do I have primary hyperparathyroidism?

In most cases, persistently high calcium levels indicate primary hyperparathyroidism. But we need more information to confirm the diagnosis. To diagnose primary hyperparathyroidism, we check the calcium and PTH together. If something else (not parathyroid disease) is causing the high calcium, then the normal parathyroid glands will be suppressed - that is, they will make very little hormone. Th...

FHH Diagnosis Primary HPT Hypercalcemia

Did lithium cause my parathyroid disease? Many years ago, I took lithium for several months. Recently I was diagnosed with primary hyperparathyroidism. Is the lithium to blame?

Lithium is a known cause of primary hyperparathyroidism, but likely did not cause it in this case. Lithium-associated primary hyperparathyroidism usually occurs after many years (think decades) of lithium therapy. It can cause parathyroid disease in less time, but if the lithium was only taken for several months, many years ago, it is most likely unrelated. Interestingly, lithium-associated...

Primary HPT Multigland disease Lithium Hyperplasia

When can I expect to feel better after surgery? I’ve been feeling terrible.

This is a great question. Unfortunately there isn’t a single answer for everyone. On average, most people will feel better within a few weeks after surgery, and this improvement can continue for months. But that is just the average. I have had patients who wake up after surgery and felt like a cloud was lifted. They feel amazing, right after the operation. These patients are rare, but they happ...

Outcomes Primary HPT Operation Postop expectations FAQ

What causes primary hyperparathyroidism?

Primary hyperparathyroidism is usually caused by a benign tumor in one or more of the parathyroid glands. In most cases, the tumor grew spontaneously. It was not due to anything that you did, and we do not have an explanation for why it occurred. There are a few known conditions that will cause primary hyperparathyroidism, though these only apply to a small number of patients. Here are the ...

What is Parathyroid Disease?

Parathyroid disease refers to problems with the parathyroid glands. Almost everyone has four parathyroid glands, located in the neck near the thyroid. These glands exist to regulate blood calcium levels, so parathyroid disease is fundamentally a problem of calcium. The calcium in your blood is kept in a very tight range - your body doesn't want it too low or too high. The parathyroids are what ...

Diagnosis Primary HPT Secondary HPT Popular Parathyroid Disease Basics FAQ

Hi Dr Boone. I have high calcium. Does it mean I have parathyroid disease? Also your website doesn’t mention primary parathyroid disease. Is it by design? Thanks.

High calcium is almost always caused by parathyroid disease (specifically, primary hyperparathyroidism), but just knowing a calcium level is not enough for a definitive diagnosis. We also need to see a PTH level. Once you have a calcium and PTH level together (ideally taken from the same day), you can usually make the diagnosis. A high calcium combined with a high or normal PTH is diagnostic of...

Diagnosis Primary HPT

I've had high calcium levels for the last four years. Over the last six months I have started having more frequent headaches and body aches. Sometimes I feel really tired even when getting lots of sleep. I think these symptoms may be due to parathyroid disease, but on other days I feel just fine, so I think they may be caused by something else. Can symptoms of parathyroid disease come and go like this?

Yes, it is common for the symptoms of parathyroid disease to come and go. Patients will report that on some days they are too tired to get out of bed, but other days feel great. Often, the symptoms of primary hyperparathyroidism will gradually increase in frequency and severity. Many people start out not feeling all that bad, but then after a few years with the disease they notice that they are...

Symptoms Primary HPT

What are the most common symptoms of primary hyperparathyroidism?

Primary hyperparathyroidism can affect multiple organ systems and produce many different symptoms. The most common symptoms of parathyroid disease are **fatigue and a general sense of not being well.** Most patients will report some fatigue, which can range from mild tiredness to severe fatigue that makes it difficult to work or perform normal daily activities. This, along with other symptoms, ...

Symptoms Popular Primary HPT FAQ

Hi Dr. Boone, Can hyperparathyroidism cause MGUS? If so, are you aware of any patients whose MGUS healed after parathyroidectomy? Thank you.

This is a very good question, and somewhat difficult to answer. Here is the short answer: We do not have definitive evidence that parathyroid disease causes MGUS or that MGUS will resolve after parathyroidectomy. Long answer: Monoclonal gammopathy of undetermined significance (MGUS) is a condition characterized by abnormal proteins in the blood. In most cases, this condition is benign a...

I had a calcium level of 10.6 and then 10.4 on a recheck a week layer. PTH is 58. I am 56 years old. I will discuss with doctor. He might say it is normal and to monitor. Any thoughts?

Thanks for posting your question! From the information that you have given, it looks like you have parathyroid disease. At your age, calcium levels of 10.6 and 10.4 mg/dl are definitely not normal, and usually indicate primary hyperparathyroidism. To diagnose this, we also need the PTH level. Your PTH level is in the higher end of normal, which means that you have primary hyperparathyro...

Diagnosis Primary HPT

Does parathyroid surgery have to be performed for primary hyperparathyroidism if I don't have any symptoms? Can nutrition or natural medicine correct hyperparathyroidism?

The only known cure for primary hyperparathyroidism (pHPT) is an operation: parathyroidectomy. It's natural to wonder whether this needs to be done, though, if you aren't experiencing any ill effects from the condition. Many patients with pHPT report symptoms like fatigue, brain fog, low energy, body aches, and insomnia. But a few patients say that they feel just fine. These patients often ask ...

Operation Primary HPT Treatment