Hyperparathyroidism Hohenga rawaka o te taha repe tenga

You have 4 parathyroid glands in your neck. Each one is about the size of a grain of rice and they sit behind your thyroid gland. The parathyroid hormone they make controls the amount of calcium and phosphate in your body.

The most common cause of hyperparathyroidism is a benign (non- cancerous) tumour in one of your parathyroid glands, called an adenoma.

It may also be caused by your parathyroid glands becoming enlarged and overactive. This is called hyperplasia.

Very rarely, hyperparathyroidism may be caused by a cancer of the parathyroid gland.

Excess parathyroid hormone affects women more than men and usually starts after menopause. It is very rare in younger people.

When you have too much parathyroid hormone, you get too much calcium in your blood (hypercalcaemia).

For most people, this does not cause any symptoms. The condition is usually picked up from a high blood calcium test that has been done for another reason.

In mild hyperparathyroidism, if you get symptoms these may include:

• joint aches
• fatigue
• weakness
• loss of appetite
• tummy pain
• mild depression.

If your blood calcium is very raised, you may:

• have hard poos (constipation)
• have a significant loss of appetite
• feel sick (nausea)
• be confused
• feel very thirsty and pass a lot of wee (urine).

If hyperparathyroidism is not treated, it can lead to complications including:

• kidney stones
• impaired kidney function
• thin and weak bones (osteoporosis)
• joint problems
• high blood pressure, which can increase your risk of heart disease and stroke.

If very severe and left untreated, hyperparathyroidism can lead to:

• confusion
• loss of consciousness
• abnormal heart rhythm
• death.

If you have hyperparathyroidism, a blood test will show high calcium and usually low phosphate. It will also pick up high levels of parathyroid hormone.

You may also need a urine test. You will need to collect all the wee you pass in 24 hours and this will be checked to see how much calcium is in it. This can help determine if you need treatment.

You may need a scan of your parathyroid glands.

You may also need to have a bone density scan to check the thickness of your bones. If your healthcare provider thinks you might have kidney stones, you may also need a kidney scan.

Your treatment will depend on how high your calcium levels are and how bad your symptoms are.

If your calcium is just slightly higher than normal and you do not have any symptoms, you will not need any treatment. You will need a blood test every 6 to 12 months to check that your calcium levels are not rising.

Surgery

If your hyperparathyroidism needs to be treated, you will have surgery to remove the parathyroid gland or glands causing the problem.

The surgery is usually straightforward, but you will need to stay in hospital for a couple of days.

Occasionally, surgery can damage your other parathyroid glands and you can get low calcium levels. You will have regular blood tests after surgery to check this. You might also get a hoarse voice following surgery, which may be temporary or permanent. Very occasionally, the surgery will not work, and your symptoms will return.

Medicine

There is a medicine called cinacalcet that reduces the amount of parathyroid hormone you make. It is usually only given if surgery is not possible — for example, if you have other health conditions that would make the risk of surgery too high.

If you have hyperparathyroidism and are not being treated, or if the surgery has not fully solved the problem, you can do several things to look after yourself.

• Make sure you drink enough fluid. If you get dehydrated, your calcium levels can get even higher, and you can start to feel unwell.
• Keep physically active. Including muscle strengthening exercises to help to maintain strong bones.
• Do not smoke as this can increase bone loss and increase your risk of other serious health problems.
• Tell your healthcare provider you have hyperparathyroidism before you start new medicines.
• See a healthcare provider to get a blood test if you have repeated throwing up (vomiting) or runny poos (diarrhoea).