Hyperparathyroidism Symptoms, Causes, and Treatment - Dr. Michael Ruscio, DC

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Hyperparathyroidism Symptoms, Causes, and Treatment

Take Action Now to Balance Your Levels of Parathyroid Hormone and Calcium

Key Takeaways:

  • Hyperparathyroidism is caused by high PTH (parathyroid hormone) levels that make your blood calcium levels rise.
  • Hyperparathyroidism symptoms include weakened bones, muscle weakness, kidney stones, fatigue, and digestive symptoms.
  • Menopausal women are most commonly affected by an overactive parathyroid.
  • Underlying causes include a benign growth on the parathyroid gland, an underactive thyroid, and poor gut health
  • Medication or surgery may be needed for some cases of hyperparathyroidism.
  • Milder symptoms may respond to a gut-healthy diet and vitamin D supplementation.

Most of us are familiar with the thyroid and the issues that can go wrong with this metabolism-regulating gland, namely being either underactive or overactive. But similar issues can also affect the parathyroid gland, which is closely connected to the thyroid and controls your blood calcium levels.

Menopausal women are most commonly affected by an overactive parathyroid, and the result (without corrective action) can be weaker bones.

I’m sometimes asked whether the information I share about thyroid issues is relevant for parathyroid issues as well, so let’s dig into all this a bit further.

We’ll delve into what the parathyroid gland does, what hyperparathyroidism symptoms to look out for, and how to deal with the health issues they may cause.

What Your Parathyroid Gland Does

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The parathyroid is actually not one, but four small glands that are located behind the butterfly-shaped thyroid gland in your neck. The parathyroid secretes parathyroid hormone (PTH), which is responsible for maintaining blood calcium levels within tight limits [1].

Keeping blood calcium at the correct level is important for heart, kidney, bone, and nervous system functioning [2].

When your parathyroid is working as it should, it produces the right amount of PTH to stop your blood calcium from dropping too low or rising too high [1]. PTH is released due to falling blood calcium, which increases your circulating calcium by:

  • Stimulating the bones to release a higher amount of calcium into the blood.
  • Telling your kidneys to return calcium to the blood rather than flushing it out in your urine.
  • Increasing production of an enzyme that converts vitamin D into its active form (calcitriol). Vitamin D magnifies the effects of PTH by also telling bone to release calcium, and the intestine to absorb more of the mineral.

What Causes Hyperparathyroidism Symptoms?

Primary hyperparathyroidism is defined as the overproduction and release of PTH, which causes high levels of calcium in the blood (hypercalcemia). Though it occurs in less than 1% of the general population, it is more common in women, particularly women who have gone through menopause [3, 4].

One study estimated that as many as 3.4% of postmenopausal women may have hyperparathyroidism and high blood calcium levels. The most common cause in this age group is a benign growth within the parathyroid known as a parathyroid adenoma [1, 5].

Secondary hyperparathyroidism is when the parathyroid glands become overactive in response to another condition that causes calcium loss. Examples of conditions that cause low calcium and cause secondary hyperparathyroidism include kidney failure, and severe vitamin D deficiency or calcium deficiency. 

Symptoms of Hyperparathyroidism

If you only have mild hyperparathyroidism, there may be few or no symptoms. But when it becomes more advanced, there can be a progressive depletion of calcium from the bone, which leads to osteoporosis (bone thinning and bone fractures).

Some symptoms can be quite nonspecific, including the likes of [1, 5]:

  • Poor appetite, constipation and other digestive symptoms
  • Fatigue and low mood
  • High blood pressure

These are all fairly general and could mean anything. But if accompanied by combined musculoskeletal and urinary system symptoms, i.e. you have bone pain, joint pain, kidney stones (calcification), and increased thirst/urination, it’s worth getting your parathyroid activity checked, especially if you’re an older female, which is the highest risk group.

Hyperparathyroidism Treatments

Patients who suspect they have a parathyroid issue should see a doctor to have their symptoms assessed and their calcium, PTH, and vitamin D levels checked. You’ll probably also need kidney function tests, and a bone mineral density analysis [6]. 

If you have too much parathyroid hormone, there are various treatments that you can discuss with your healthcare provider that might help. 

The most effective of these may be to have one or more of your parathyroid glands removed. This is the recommended treatment when your hyperparathyroidism is being caused by a benign adenoma growth for example.

Another option is medication to bring down PTH. Common medications include Cinacalcet and phosphate binders.

Self-Help Measures

More minor cases of hyperparathyroidism may just require a watchful eye on your calcium levels and PTH levels and no immediate treatment. If this is the case you can help stay healthy longer by [7]:

  • Staying well hydrated
  • Doing plenty of exercise, especially impact exercises like running, skipping rope, and lifting weights, to keep your bones strong
  • Avoiding medications that can increase the level of calcium in your blood (thiazide diuretics and lithium)

Improving Thyroid and Gut Health to Prevent Parathyroid Problems

The thyroid and parathyroid glands are in close physical proximity in the body. But they are also linked physiologically, meaning that a thyroid issue makes it more likely that you will also have a parathyroid issue and vice versa. 

Both glands actually have a role in controlling calcium levels. Preventing blood calcium levels from dropping too low is the parathyroid’s primary role, but the thyroid gland (while primarily being a controller of metabolism) has a secondary role, which is to bring down blood calcium levels that are too high. The thyroid does this by secreting the hormone calcitonin [8, 9].

Some research has indicated that people with an underactive thyroid due to an autoimmune disease (Hashimoto’s thyroiditis) are more likely to have hyperparathyroidism [10].

Hypothyroidism slows down many body processes including the turnover of bone, which can cause parathyroid hormone and vitamin D levels to rise in response. In some cases, this can lead to hyperparathyroidism, characterized by higher levels of calcium than is healthy in the blood and lower levels than is normal in the urine [11].

Evidence from one study suggested that the rate of primary hyperparathyroidism may be around six times higher in those with Hashimoto’s disease than in the general population [10].

This raises the possibility that by tackling your thyroid health and managing the underlying autoimmunity behind Hashimoto’s disease and thyroid underactivity, you may also prevent hyperparathyroidism.

Given most autoimmune conditions arise in the gut [12], the wider picture is that you may improve both your thyroid and parathyroid health by improving gut health, particularly the health of the microbiome.

In support of this:

  • One study found that people with gut dysbiosis in the form of SIBO (small intestinal bacterial overgrowth) were more likely to have impaired thyroid function than healthy controls [13].
  • Studies have also linked the development of autoimmune thyroid disease with a higher prevalence of gluten sensitivity [14, 15, 16, 17], leaky gut, and low stomach acid [18, 19].
  • Though more human research is needed, recent animal studies and in vitro research (summarized in a 2020 literature review) point to the fact that a healthy gut microbiota may promote a healthy response to parathyroid hormone, resulting in better bone health [20].
  • Studies also show that gut dysbiosis may be associated with altered levels of parathyroid hormone (PTH) and calcium [4, 21]. 

What is the Mechanism Here?

One theory is that dysbiosis creates gut leakiness in the gut lining, allowing antigens to enter the bloodstream and stimulating autoimmune illnesses, including hypothyroidism (Hashiomoto’s thyroiditis) [22].  

As outlined above, hypothyroidism may in turn make hyperparathyroidism more likely.

Both hyperparathyroidism and hypoparathyroidism (low PTH and low blood calcium) hyperparathyroidism) may also be considered autoimmune diseases [1, 23]. 

  • Co-existent autoimmune disease was observed in over a quarter of patients with inflammation in the parathyroid in one study [23]. 

The bottom line seems to be that watching your gut health can reduce your risk of hyperparathyroid disease, either directly or via a boost to thyroid health.

Your Healthy Eating Plan for Parathyroid Health

There’s no specific diet that has been found to help with hyperparathyroidism symptoms, but eating to heal your gut, so it isn’t leaky or inflamed, is the logical way to go.

When I talk to my patients about the best diet for gut health, I don’t like to be prescriptive, because everyone is different. However to maintain a healthy gut, and promote a healthy microbiome you should generally aim to eat an anti-inflammatory diet that: 

  1. Is made primarily of real, whole foods
  2. Çontains minimal sweeteners and processed foods
  3. Contains the right ratio of carbs, healthy fats, quality proteins, and fiber for you 
  4. Avoids your unique food sensitivities and food allergies 

A few diets, particularly the paleo and low FODMAP diets, meet these criteria. They check off points 1 and 2 above but have differing approaches when it comes to points 3 and 4. 

I advise my patients to try the Paleo diet first as it cuts down on the main culprits that people with food sensitivities tend to react to (like wheat and dairy) but isn’t overly restrictive in terms of its content of prebiotic fibers. (Prebiotics are carbohydrates that are ordinarily good for us but which can stimulate a general overgrowth of bacteria in those whose gut is unusually sensitive).

If you still have gut or hyperparathyroidism symptoms after a few weeks eating paleo, you might want to a low FODMAP diet instead.

Supplements That Could Help

Probiotics are the obvious choice here as they have proven effects in [24, 25, 26, 27, 28, 29]

  • Healing a leaky gut
  • Balancing bacterial overgrowth and overall gut flora 
  • Decreasing gut inflammation

Probiotics may also act more directly with regards to parathyroid and bone health.

In one meta-analysis of studies looking at postmenopausal women, it was found that probiotics beneficially altered bone parameters including blood serum calcium, urinary calcium, and PTH levels [30]. The clinical implications are unclear, but it is an interesting finding that supports the link between having a healthy microbiome and avoiding hyperparathyroidism symptoms.

Vitamin D is another supplement that could be of benefit if you have hyperparathyroidism symptoms. Many patients with primary hyperparathyroidism have low vitamin D, which can further impair bone health. In fact, it is a two-way relationship — Vitamin D deficiency exacerbates primary hyperparathyroidism and vice versa [31].

Some people like to take vitamin D in conjunction with vitamin K2 as the two have been shown to augment the effects of each other when it comes to bone health [32].

Hyperparathyroidism Symptoms Can Be Improved 

Hyperparathyroidism symptoms aren’t particularly common, but you shouldn’t rule out that your parathyroid gland is the problem if your blood calcium levels are high or you are running into bone health issues, especially if you are a woman who has recently gone through the menopause.

Having an underactive thyroid may increase your risk of hyperparathyroidism, and both conditions may stem from poor gut health.

Optimizing gut health may decrease your chances of developing thyroid and parathyroid issues, but hyperparathyroidism symptoms should always be checked out as medication, or sometimes parathyroid surgery, may sometimes be needed.

Any thyroid or parathyroid disorder can have consequences if left untreated, so do seek medical attention if you experience symptoms that might suggest either is out of balance.

You can also reach out to our experienced practitioners at the Ruscio Institute for Functional Health for any hormonal imbalance or thyroid/parathyroid tissue,

Another resource that might be useful is the step-by-step guide to better gut and general health detailed in my book Healthy Gut, Healthy You.

The Ruscio Institute has developed a range of high-quality formulations to help our patients and audience. If you’re interested in learning more about these products, please click here. Note that there are many other options available, and we encourage you to research which products may be right for you.

➕ References
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  3. Press DM, Siperstein AE, Berber E, Shin JJ, Metzger R, Monteiro R, et al. The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record. Surgery. 2013 Dec;154(6):1232–7; discussion 1237. DOI: 10.1016/j.surg.2013.06.051. PMID: 24383100.
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