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2024 11:30 Patient education: Primary hyperparathyroidism (The Basics) - UpToDate

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Patient education: Primary hyperparathyroidism (The

Basics)
Written by the doctors and editors at UpToDate

Please read the Disclaimer at the end of this page.

What is primary hyperparathyroidism?

This is a disorder of the parathyroid glands in the neck ( figure 1). These glands make a
hormone called "parathyroid hormone," or "РTΗ." It helps control the amount of calcium in the
blood.

Primary hуреrраrаthуrοidiѕm is when the parathyroid glands make too much ΡTН. This can
cause too much calcium to build up in the blood. It can happen when a gland develops an
abnormal benign (non-cancer) growth. It can also happen when 1 or more of the glands grow
too big. Parathyroid cancer is a very rare cause of primary hуреrраrаthуrоiԁiѕm.

What are the symptoms of primary hyperparathyroidism?

Most people have no symptoms. But some have symptoms that might be related to having too
much calcium in their blood. These symptoms include:

● Pain in the joints

● Feeling tired or weak
● Loss of appetite
● Feeling depressed
● Trouble concentrating

If your blood calcium levels get very high, you might get constipated, feel very thirsty, or urinate
more often than usual. Some people have more serious problems, such as:

● Problems with how the kidneys work

● Kidney stones
● Weak bones
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"Parathyroid crisis" is a rare but serious problem. It can happen if you have primary
hуреrраrаthуroidism and get sick with something that causes you to lose fluids (like vomiting or
diarrhea). This causes the amount of calcium in the blood to suddenly rise to a very high level. If
this happens, you might have belly pain, nausea, and sometimes problems thinking clearly and
staying alert.

Is there a test for primary hyperparathyroidism?

Yes. A doctor or nurse can do tests to measure the levels of ΡTН and calcium in your blood.
Many people with primary hуреrраrаthуrоiԁiѕm do not notice any symptoms. The condition is
often found when a doctor or nurse does a blood test for another reason.

If you have primary hуреrраrаthуroiԁism, your doctor or nurse might do other tests, too. You
will probably get a special kind of X-ray to see if your bones are weaker than normal. Plus, you
might get checked for kidney stones.

What can I do on my own?

Even if you do not have any symptoms, there are things that you can do to help prevent
problems:

● Drink plenty of liquids, and try not to get dehydrated. This can help prevent kidney stones.

● Stay active. This can help keep your calcium levels normal and your bones healthy.

● Try to get about 1000 milligrams of calcium each day. These tables show how much
calcium is in certain foods and vitamin supplements ( table 1 and table 2). It is better
to get your calcium from foods and drinks rather than supplements ( figure 2). Some
people might need to reduce the amount of calcium in their diet. Your doctor will talk to
you about how to make sure that you get the right amount of calcium.

● Try to get about 400 to 800 international units, or "IU," of vitamin D each day ( table 3).
This is the same as 10 to 20 micrograms of vitamin D. Not having enough vitamin D can
weaken your bones.

● Do not take certain medicines that can affect the amount of calcium in your blood. Your
doctor or nurse can tell you which medicines to avoid.

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How is primary hyperparathyroidism treated?

The main treatment is ѕurgеrу to remove the gland or glands that are causing the problem.
Surgеry usually cures the condition. Still, people who have no symptoms do not always need
ѕսrgеry.

You will most likely need ѕսrgerу if:

● The amount of calcium in your blood is much higher than normal.

● Your primary hуреrраrаthyrоiԁism is causing problems with your kidneys or bones.
● You are younger than 50.
● You cannot get regular check-ups and tests.

If you do not need ѕurgеry, your doctor or nurse should still check your blood calcium every 6
months. They will also do regular tests to check your kidneys and bones.

Rarely, a person cannot have ѕսrgеry. In this case, they can take medicine instead. These do not
cure primary hуреrраrаthyrοidism, but they can help:

● Strengthen your bones

● Lower the amount of calcium in your blood

When should I call the doctor?

Call your doctor or nurse if:

● Your symptoms are getting worse.

● You have bone or joint pain.

● Your feet, ankles, or legs are swollen.

● You feel weak or very tired.

● You feel very thirsty.

● You are urinating more often than usual.

● You have vomiting or diarrhea and cannot keep fluids down.

● You have symptoms of a kidney stone, such as:

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• Pain in your side or the lower part of your belly

• Nausea or vomiting
• Pain when urinating
• Needing to urinate in a hurry

More on this topic

Patient education: Osteoporosis and osteopenia (low bone mass) (The Basics)
Patient education: Bone density testing (The Basics)
Patient education: Calcium and vitamin D for bone health (The Basics)
Patient education: Calcium blood test (The Basics)
Patient education: Hypercalcemia (The Basics)
Patient education: Kidney stones in adults (The Basics)

Patient education: Primary hyperparathyroidism (Beyond the Basics)

Patient education: Osteoporosis prevention and treatment (Beyond the Basics)
Patient education: Bone density testing (Beyond the Basics)
Patient education: Calcium and vitamin D for bone health (Beyond the Basics)
Patient education: Kidney stones in adults (Beyond the Basics)
All topics are updated as new evidence becomes available and our peer review process is complete.

This topic retrieved from UpToDate on: Oct 18, 2024.

Disclaimer: This generalized information is a limited summary of diagnosis, treatment, and/or

medication information. It is not meant to be comprehensive and should be used as a tool to
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NOT include all information about conditions, treatments, medications, side effects, or risks
that may apply to a specific patient. It is not intended to be medical advice or a substitute for
the medical advice, diagnosis, or treatment of a health care provider based on the health care
provider's examination and assessment of a patient's specific and unique circumstances.
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information is governed by the Terms of Use, available at
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and its affiliates and/or licensors. All rights reserved.
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GRAPHICS

Thyroid and parathyroid glands

The thyroid is a butterfly-shaped gland in the middle of the neck. It sits just below the larynx (voice box).
The thyroid makes 2 hormones, called T3 and T4, which control how the body uses and stores energy.
The parathyroid glands are 4 small glands behind the thyroid. They make a hormone called parathyroid
hormone, which helps control the amount of calcium in the blood.

T3: triiodothyronine; T4: thyroxine.

Graphic 66834 Version 10.0

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Foods and drinks with calcium

Food Calcium in milligrams

Milk (skim, 2%, or whole; 8 oz [240 mL]) 300

Yogurt (6 oz [168 g]) 250

Orange juice (with calcium; 8 oz [240 mL]) 300

Tofu with calcium (0.5 cup [113 g]) 435

Cheese (1 oz [28 g]) 195 to 335 (hard cheese = higher calcium)

Cottage cheese (0.5 cup [113 g]) 130

Ice cream or frozen yogurt (0.5 cup [113 g]) 100

Fortified non-dairy milks (soy, oat, almond; 8 oz [240 300 to 450

mL])

Beans (0.5 cup cooked [113 g]) 60 to 80

Dark, leafy green vegetables (0.5 cup cooked [113 50 to 135

g])

Almonds (24 whole) 70

Orange (1 medium) 60

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Examples of calcium supplements

Elemental calcium
Calcium compound Vitamin D
per tablet

Caltrate 600 + D3 600 mg Carbonate 800 units (20 mcg)

Caltrate 600 + D3 Soft 600 mg Carbonate 800 units (20 mcg)

Chews

Caltrate Gummy Bites 250 mg Tribasic calcium 400 units (10 mcg)
phosphate

Caltrate 600 + D3 Plus 600 mg Carbonate 800 units (20 mcg)

Minerals Chewables

Caltrate 600 + D3 Plus 300 mg Carbonate 800 units (20 mcg)

Minerals Minis

Citracal Petites 200 mg Citrate 250 units (6.25 mcg)

Citracal Maximum 315 mg Citrate 250 units (6.25 mcg)

Citracal Plus 250 mg Citrate 125 units (3.12 mcg)

Magnesium & Minerals

Citracal + D Slow 600 mg Citrate + carbonate 500 units (12.5 mcg)

Release blend

Citracal Calcium 250 mg Tricalcium phosphate 500 units (12.5 mcg)

Gummies

Citracal Calcium Pearls 200 mg Carbonate 500 units (12.5 mcg)

Os-Cal Calcium + D3 500 mg Carbonate 200 units (5 mcg)

Os-Cal Extra + D3 500 mg Carbonate 600 units (15 mcg)

Os-Cal Ultra 600 mg Carbonate 500 units (12.5 mcg)

Os-Cal Chewable 500 mg Carbonate 600 units (15 mcg)

Tums 200 mg Carbonate –

Tums Extra Strength 300 mg Carbonate –

Tums Ultra Strength 400 mg Carbonate –

Tums Chewy Delights 400 mg Carbonate –

Viactiv Calcium plus D 650 mg Carbonate 500 units (12.5 mcg)

+K

These are examples of calcium supplements. You can also find other brands, as well as generic versions,
in most pharmacies.

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Foods and drinks with calcium and vitamin D

Some foods and drinks are rich in both calcium and vitamin D. These usually have calcium or vitamin D
added. Examples include milk, yogurt, ready-to-eat cereals, and plant-based "milks" (such as soy and
almond milk).

Foods that are only rich in calcium include ice cream, breads, kale, broccoli, cheese, cottage cheese,
almonds, beans, and tofu. These have less calcium per serving than the foods above that have both
calcium and vitamin D.

Foods that are only rich in vitamin D include many types of fish (such as tuna fish, salmon, sardines, and
mackerel), cod liver oil, and eggs.

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Selected food sources of vitamin D [1]

Amount per serving

Food
In international In micrograms
units (IU) (mcg)

Cod liver oil, 1 tablespoon (15 mL) 1360 34

Salmon (sockeye), cooked, 3 ounces (85 g) 380 to 570 * 9.5 to 14 *

Mushrooms that have been exposed to ultraviolet light to 889 22.3

increase vitamin D, 3 ounces (85 g) (not yet commonly
available)

Mackerel, cooked, 3 ounces (85 g) 388 9.7

Tuna fish, canned in water, drained, 3 ounces (85 g) 40 to 68 1 to 2

Milk, nonfat, reduced fat, and whole, vitamin D-fortified, 8 100 2.5
ounces (240 mL)

Orange juice fortified with vitamin D, 8 ounces (240 mL) (check 100 2.5
product labels, as amount of added vitamin D varies)

Yogurt, fortified with vitamin D, 6 ounces (180 mL) (more 80 2

heavily fortified yogurts provide more of the DV)

Margarine, fortified, 1 tablespoon (15 g) 60 1.5

Sardines, canned in oil, drained, 2 sardines 46 1

Liver, beef, cooked, 3.5 ounces (100 g) 46 1

Ready-to-eat cereal, fortified with vitamin D, 6 to 8 ounces (227 40 1

g) (more heavily fortified cereals might provide more of the DV)

Egg, 1 whole (vitamin D is found in yolk) 25 0.6

Cheese, Swiss, 1 ounce (29 g) 6 0

In the United States, reference values are listed on food labels as a percentage of DVs (%DV), based on a
2000 calorie daily energy intake.

%: percent; DV: daily value.

* Vitamin D content of fish varies substantially even within species. Wild salmon tends to have higher
vitamin D content than farmed salmon.

Reference:
1. US Department of Agriculture, Agricultural Research Service. USDA Nutrient Database for Standard Reference, Release 28,
2017.

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