Hyperparathyroidism

Key facts

• The parathyroid glands, four small glands behind the thyroid, overproduce parathyroid hormone (PTH). Excess PTH pulls calcium from bones into the bloodstream, which over time raises the risk of osteoporosis, kidney stones and fatigue.
• Primary hyperparathyroidism comes from a problem in the gland itself. Secondary hyperparathyroidism develops as a response to low calcium, most often from chronic kidney disease or vitamin D deficiency.
• Medical management centres on correcting the calcium-vitamin D imbalance, often with an active vitamin D analogue such as alfacalcidol, alongside regular monitoring of calcium, phosphate and PTH levels.
• Surgery to remove the affected gland is the definitive option for primary disease with significantly high calcium or bone involvement.

What hyperparathyroidism is

Excess PTH signals bone to release calcium faster than it should, raising blood calcium at the bone's expense. Left unaddressed this weakens bone over time and can contribute to kidney stones from the extra calcium the kidneys have to filter. The primary form arises from an abnormality in one or more of the parathyroid glands themselves, while the secondary form is the body's response to persistently low calcium, most commonly driven by chronic kidney disease or vitamin D deficiency.

Managing calcium and bone health

The backbone of medical management is correcting the underlying calcium-vitamin D imbalance. Active vitamin D analogues such as alfacalcidol restore normal calcium absorption and suppress PTH production, and are commonly used for secondary hyperparathyroidism linked to kidney disease. Alongside medicine, regular monitoring of serum calcium, phosphate and PTH levels guides dose adjustments, and bone health should be assessed periodically. For primary hyperparathyroidism with significantly elevated calcium or bone involvement, surgical removal of the affected gland is the definitive treatment.

When to see a doctor

See a doctor promptly for muscle weakness, persistent fatigue, frequent kidney stones or unexplained bone pain, and ask for your calcium and PTH levels to be checked.

This page is educational and does not replace advice from a doctor or pharmacist who knows your health history.