Calcium is an essential mineral that keeps our bones strong and allows our muscles, nerves, and heart to work properly. But just like most things in life, too much of a good thing can be bad. When calcium levels in the blood become too high, a condition called hypercalcemia can develop. One of the most common causes of hypercalcemia is hyperparathyroidism — a condition where the parathyroid glands in the neck become overactive.
What are the parathyroid glands?
Most people are familiar with the thyroid gland, but fewer know about the parathyroid glands. These are four tiny glands, each about the size of a grain of rice, located behind the thyroid. Their main job is to control calcium levels in the body. They do this by releasing parathyroid hormone (PTH), which signals the bones to release calcium into the bloodstream, helps the intestines absorb calcium from food, and prompts the kidneys to hold on to calcium instead of flushing it out.
How common is it?
Hyperparathyroidism is not extremely rare. In fact, it is considered one of the more common causes of high blood calcium levels. It is estimated to affect about 1 in 1,000 people, and it is more common in women, especially those over the age of 50. Some people may go for years without knowing they have it because early symptoms can be mild or mistaken for other things.
Causes of hypercalcemia and hyperparathyroidism
Hypercalcemia can have several causes, but when it is due to hyperparathyroidism, it usually means that one or more of the parathyroid glands have developed a small, non-cancerous growth called an adenoma. This growth causes the gland to pump out too much PTH, leading to too much calcium in the blood.
Other causes of hypercalcemia include:
• Certain cancers, like lung or breast cancer
• Overuse of calcium or vitamin D supplements
• Some medications, like thiazide diuretics
• Prolonged immobility, which can cause calcium to leak from bones
But among these, primary hyperparathyroidism is the leading cause of high calcium levels detected during routine blood tests.
Symptoms to watch out for
The tricky part about hyperparathyroidism is that many people don’t have obvious symptoms at first. When symptoms do appear, they can vary widely and may include:
• Fatigue and weakness
• Frequent urination and dehydration
• Abdominal pain, nausea, or constipation
• Bone pain or fractures from weakened bones
• Kidney stones
• Memory problems, depression, or difficulty concentrating
How is it diagnosed?
Doctors usually detect hypercalcemia through routine blood tests that show elevated calcium levels. If this happens, they will often check the parathyroid hormone (PTH) level. A high calcium level along with a high PTH level strongly points to hyperparathyroidism.
Additional tests like bone mineral density scans, kidney ultrasounds, or special imaging of the neck and chest to locate overactive parathyroid glands may also be done.
Treatment options
Treatment depends on the severity of the condition and whether the patient has symptoms. For mild cases, doctors may recommend careful monitoring, staying well-hydrated, and avoiding calcium supplements.
For more serious cases or when symptoms are present, surgical removal of the overactive parathyroid gland is often the best option. This surgery is usually curative and PTH levels are monitored during the operation to ensure the correct parathyroid gland was removed.
If surgery is not possible, medications may be prescribed to lower calcium levels or to help prevent bone loss.
Possible complications
If left untreated, hypercalcemia and hyperparathyroidism
can lead to:
• Kidney stones or even kidney damage
• Osteoporosis and bone fractures
• Heart problems, including abnormal heart rhythms
• Reduced quality of life due to chronic fatigue and mood issues
This past week I had a patient undergo surgery to remove an enlarged parathyroid gland. She had been feeling “off” for years — tired, forgetful, and dealing with kidney stones and osteoporosis. She chalked it up to age and stress, but a routine blood test revealed high calcium levels. Further testing confirmed hyperparathyroidism. Thankfully, we caught it fairly early, and she should be feeling much better soon.
If you or someone you love has unexplained fatigue recurrent kidney stones, or changes in mood or memory, don’t ignore it. Ask your doctor to check your calcium and parathyroid hormone levels. With timely diagnosis and the right treatment, most patients recover well and can feel like themselves again.