What is hyperparathyroidism?

Hyperparathyroidism is a condition that is developed due to excessive activity in one or more parathyroid glands, which are a grain-sized structure located behind the thyroid in the neck. The parathyroid gland is responsible for creating parathyroid hormone (PTH), which plays a vital role in boosting and regulating the calcium levels in the bloodstream when necessary. Additionally, there are 3 types of hyperparathyroidism, including:

Primary hyperparathyroidism: refers to the enlargement (hyperplasia) of one or more parathyroid glands, causing excess production of PTH to a point where the body does not interpret the body’s signal to halt PTH production.
Secondary hyperparathyroidism: parathyroid glands producing excessive PTH to increase calcium levels and lower phosphate levels due to conditions that result in high phosphate levels, low calcium levels and low vitamin D.
Tertiary hyperparathyroidism: prolonged secondary hyperparathyroidism that does not respond to treatments. As a result, the parathyroid glands become enlarged and continue to produce PTH.

What causes hyperparathyroidism?

Generally, hyperparathyroidism is caused by several factors that contribute to the overproduction of PTH. Depending on the type of hyperparathyroidism, some of the known causes include:

Primary hyperparathyroidism

Adenoma: an adenoma is a noncancerous growth that is developed on the parathyroid gland.
Enlargement (hyperplasia): when one or more parathyroid glands become enlarged, then it leads to hyperparathyroidism.
Parathyroid cancer: although rare, it is possible for parathyroid cancer to cause hyperparathyroidism.

Secondary hyperparathyroidism

Chronic kidney failure: as the kidney loses its ability to convert vitamin D into forms that the body needs, it inherently lowers calcium levels, which triggers PTH levels to increase.
Severe calcium deficiency: due to the digestive system’s inability to absorb calcium, it leads to severe calcium deficiency, which causes secondary hyperparathyroidism.
Severe vitamin D deficiency: when the body produces or receives a small amount of vitamin D, it hinders the digestive system’s ability to absorb calcium. As a result, it leads to secondary hyperparathyroidism.

What are the symptoms of hyperparathyroidism?

Some of the symptoms of hyperparathyroidism include:

Appetite loss
Bone or joint pain
Constipation
Depression
Difficulties concentrating
Fatigue
Forgetfulness
Frequent urination
Increased thirst
Muscle weakness
Nausea
Vomiting episodes

There are incidences whereby hyperparathyroidism does not produce any symptoms. As such, some people are diagnosed with hyperparathyroidism during a routine blood test.

If you have been experiencing the above symptoms, then we do encourage you to contact us to have it further examined to receive an accurate diagnosis.

What are the known risk factors of hyperparathyroidism?

Some risk factors that increase your likelihood of developing hyperparathyroidism include:

Gender: women are more susceptible to hyperparathyroidism compared to men.
Kidney diseases or damage: your chance of developing hyperparathyroidism is increased if you have kidney diseases or sustained any kidney damage.
Lithium medication: if you are on lithium, which is a medication often used to treat bipolar disorder, then you are more likely to develop hyperparathyroidism.
Medical conditions: if you are diagnosed with multiple endocrine neoplasia or type 1 diabetes, then you have an increased risk of developing hyperparathyroidism.
Vitamin deficiencies: you have an increased risk of developing hyperparathyroidism if you have a vitamin D deficiency.

How is hyperparathyroidism diagnosed in Singapore?

Hyperthyroidism is typically diagnosed during a routine blood test, to check for calcium or PTH levels. In the event our doctor notices an elevated calcium or PTH level, he may order the following tests to confirm a diagnosis:

Blood test: a second blood test may be ordered to confirm the calcium and PTH levels in your blood.
Bone mineral density test: a bone mineral density test is often ordered to confirm osteoporosis. One of the most common tests is dual-energy X-ray absorptiometry (DEXA), which uses a specialised X-ray device to measure the volume of calcium and other bone minerals that are packed into a bone segment.
Kidney imaging test: a kidney imaging test will help our specialist determine the presence of kidney stones or other kidney-related issues that may contribute to hyperparathyroidism.
Parathyroid scan: a parathyroid scan, better known as a sestamibi scan, offers our doctor a closer look at which parathyroid glands are producing excess PTH. Usually, a parathyroid scan is often performed before a surgical treatment to determine which glands should be removed.
Urine test: a urine test is performed to determine the kidney’s functionality levels and to measure the amount of calcium that passes through your urine.

How is hyperparathyroidism treated in Singapore?

The treatment options for hyperparathyroidism depend on the cause of the condition as well as the severity of the symptoms. But generally, the treatment options are:

Primary hyperparathyroidism

Surgery is the most common treatment for primary hyperparathyroidism. It involves the removal of enlarged gland or glands affected by tumour. Surgeries are typically done as an inpatient procedure, with patients requiring at least one overnight stay. Whilst awaiting surgery you are advised to;

Drinking plenty of water lowers the risk of kidney stones.
Incorporating exercise into your daily or weekly routine will help strengthen the bones.

On the other hand, if your hyperparathyroidism results in high serum calcium and low bone density levels or disrupts your kidney functions, then our doctors will recommend a parathyroidectomy along with medications to help balance the hormones:

Parathyroidectomy: refers to a surgical treatment where the affected parathyroid glands are removed. The outcome of the treatment often results in improved bone health and reduces the risk of kidney stones.
Medications: such as calcimimetics are prescribed to signal the parathyroid glands to produce less PTH, while bisphosphonates lower the risk of osteoporosis by helping the bones retain calcium.

Secondary hyperparathyroidism

When it comes to secondary hyperparathyroidism, treatment often involves treating the underlying causes to return the PTH levels within the normal range. This will include:

Chronic kidney failure: chronic kidney failure is treated by prescribing calcium and vitamin D supplements. Additionally, our doctors will also prescribe additional medications to help control blood glucose and lower cholesterol. If you have advanced chronic kidney failure, then it may be recommended that you undergo routine dialysis to help the kidney flush out excess fluids and waste materials from your blood.
Severe vitamin D deficiency: vitamin D supplements are prescribed to treat severe cases of vitamin D deficiency.

While hyperthyroidism is not a preventable condition, it is a highly treatable condition provided it is diagnosed early. If you suspect that you may have hyperthyroidism, then we implore you to contact us to receive an accurate diagnosis, so treatment may begin.

Frequently Asked Questions

What are some of the complications that can arise from untreated hyperparathyroidism?

Untreated hyperparathyroidism can lead to complications such as:

Heart attack, stroke or high blood pressure due to calcium buildup in the blood vessels and heart.
Kidney stones due to calcium buildup in the kidneys.
Loss of kidney function.
Osteoporosis which is a condition characterised by the loss of calcium in the bones.
Skin sores and infections due to calcium buildup in the skin.

Will I have a poor quality of life if I am diagnosed with hyperparathyroidism?

No, in fact, most people with asymptomatic primary hyperparathyroidism live a normal life. However, hyperparathyroidism does progress for some people, especially if it is left untreated over the course of many years. That is why it is encouraged to undergo routine check-ups to prevent the condition from worsening.

If I am diagnosed with hyperparathyroidism, what are some of the self-care tips that I should practice?

Some of the self-care tips that you can practice to prevent your condition from worsening or to help improve your symptoms include:

Drinking plenty of fluids.
Exercising regularly.
Regularly monitor your calcium and vitamin D intake.
Quitting smoking.

Thyroid & Parathyroid

Head & Neck

Skin