Learn About Parathyroid Disorder

Parathyroid Symptoms and Common Signs Explained

Parathyroid disorders often manifest through symptoms related to abnormal calcium levels in the body. Primary hyperparathyroidism, the most common parathyroid disorder, occurs when one or more parathyroid glands become overactive and produce excess PTH. This leads to elevated blood calcium levels, causing symptoms such as fatigue, weakness, bone pain, kidney stones, and cognitive issues like memory problems and difficulty concentrating. Many patients describe feeling “moody” or depressed, and some experience abdominal discomfort and constipation.

Hypoparathyroidism, a less common condition where too little PTH is produced, causes low blood calcium levels. This can result in muscle cramps, tingling sensations around the mouth or in the fingers, anxiety, seizures, and abnormal heart rhythms. In severe cases, tetany—painful muscle spasms—can occur. What makes diagnosis challenging is that many patients with parathyroid disorders initially have subtle symptoms that might be attributed to aging or other health conditions, allowing the disorder to progress unnoticed for years.

Parathyroid Disorder Treatment Approaches Overview

Treatment for parathyroid disorders varies depending on the specific condition, its severity, and the patient’s overall health. For hyperparathyroidism, the definitive treatment is typically surgical removal of the affected parathyroid gland(s), known as parathyroidectomy. This minimally invasive procedure has a high success rate, often resolving symptoms rapidly and normalizing calcium levels. Surgeons typically identify and remove only the abnormal glands while preserving healthy parathyroid tissue.

For patients who cannot undergo surgery, medical management may include monitoring calcium levels and bone density, increasing fluid intake, maintaining regular physical activity, and avoiding dehydration. Some medications can help manage calcium levels temporarily, but they generally don’t address the underlying cause of hyperparathyroidism.

Hypoparathyroidism treatment focuses on raising and stabilizing blood calcium levels through calcium supplements and active vitamin D (calcitriol), which helps the body absorb calcium. Regular monitoring of calcium and phosphorus levels is essential, as treatment must be carefully balanced to avoid both under- and over-correction of calcium levels. In some cases, recombinant parathyroid hormone may be prescribed to replace the missing hormone directly.

Parathyroid Medication List and Management Options

Several medications are used in managing parathyroid disorders, though their role varies depending on whether the condition involves excessive or insufficient hormone production. For hyperparathyroidism, medications include:

1. Cinacalcet (Sensipar): This calcimimetic drug reduces PTH production by making parathyroid glands more sensitive to calcium levels. It’s primarily used when surgery isn’t an option.

2. Bisphosphonates: Medications like alendronate and risedronate help prevent bone loss in patients with hyperparathyroidism by inhibiting bone resorption.

3. Vitamin D and calcium supplements: Paradoxically, some patients with mild hyperparathyroidism benefit from adequate vitamin D levels to prevent secondary hyperparathyroidism.

For hypoparathyroidism management, the medication regimen typically includes:

1. Calcium supplements: Available in various forms including calcium carbonate and calcium citrate, these are foundational for maintaining adequate blood calcium levels.

2. Active vitamin D analogs: Calcitriol (Rocaltrol) or alfacalcidol help enhance calcium absorption from the intestines.

3. Recombinant human parathyroid hormone (Natpara): This injectable medication is reserved for cases that cannot be well-controlled with calcium and vitamin D alone.

4. Thiazide diuretics: These medications may help reduce urinary calcium excretion, helping maintain blood calcium levels.

Management of parathyroid disorders goes beyond medication. Regular monitoring of blood calcium, phosphorus, and vitamin D levels is essential. Bone density testing helps track the impact on skeletal health. Dietary adjustments may be recommended, and patients must stay well-hydrated. Additionally, managing comorbid conditions like kidney disease or vitamin D deficiency plays an important role in overall treatment success.

Diagnosis and Evaluation of Parathyroid Disorders

Diagnosing parathyroid disorders begins with blood tests to measure calcium, phosphorus, and PTH levels. The combination of high calcium with high or inappropriately normal PTH strongly suggests hyperparathyroidism. Additional tests may include vitamin D level measurement, bone density scans to assess bone health, and kidney function tests since parathyroid disorders can affect the kidneys.

Imaging studies help locate abnormal parathyroid glands before surgery. Ultrasound provides a non-invasive method to visualize enlarged glands, while sestamibi scans use a radioactive tracer that concentrates in overactive parathyroid tissue. In challenging cases, CT scans, MRI, or specialized PET scans may help pinpoint small or ectopically located glands. 4D-CT scanning combines multiple CT images taken over time to enhance visualization of abnormal parathyroid tissue based on their blood flow patterns.

Complications and Long-term Management

Untreated parathyroid disorders can lead to significant complications. With hyperparathyroidism, prolonged high calcium levels may cause osteoporosis, kidney stones, kidney damage, and cardiovascular problems including calcification of blood vessels. Neuropsychiatric symptoms may worsen over time, affecting quality of life.

For hypoparathyroidism, chronic low calcium can lead to cataracts, dental problems, and calcification of the basal ganglia in the brain. Long-term management requires vigilant monitoring and medication adjustments to maintain optimal calcium levels.

After successful treatment, most hyperparathyroidism patients experience rapid improvement in symptoms, though bone recovery may take longer. Regular follow-up testing ensures calcium levels remain normal. For hypoparathyroidism patients, lifelong medication and monitoring are typically necessary, with the goal of maintaining calcium levels in the low-normal range while avoiding episodes of hypocalcemia or hypercalcemia.

This article is for informational purposes only and should not be considered medical advice. Please consult a qualified healthcare professional for personalized guidance and treatment.