Hyperparathyroidism
Hyperparathyroidism is a condition in which one or more of the parathyroid glands produce excessive amounts of parathyroid hormone (PTH). The parathyroid glands play a critical role in regulating calcium levels, bone health, muscle function, and nerve activity.
When too much PTH is produced, calcium levels in the bloodstream rise. Over time, elevated calcium can weaken bones, increase the risk of kidney stones, affect kidney function, and contribute to fatigue, muscle weakness, digestive symptoms, and problems with memory or concentration. Many patients, however, have few or no symptoms and are diagnosed after routine blood work reveals elevated calcium levels.
At The Medical Group of New Jersey, our board-certified general surgeons work closely with endocrinologists, primary care physicians, radiologists, and nephrologists to evaluate hyperparathyroidism and determine when surgery is the most appropriate treatment. For many patients, removal of the abnormal parathyroid gland offers a safe, effective, and long-lasting cure.
Symptoms & Initial Evaluation
Hyperparathyroidism often develops gradually, and symptoms may be subtle for months or even years. Some patients are diagnosed before symptoms develop because elevated calcium is discovered during routine laboratory testing.
When symptoms occur, they may include:
- Fatigue or low energy
- Muscle weakness
- Bone or joint pain
- Frequent urination
- Increased thirst
- Constipation
- Nausea or decreased appetite
- Difficulty concentrating or memory problems
- Depression or mood changes
- Kidney stones
Over time, untreated hyperparathyroidism may contribute to osteoporosis, recurrent kidney stones, declining kidney function, and an increased risk of fractures.
Patients should seek prompt medical evaluation if they experience:
- Severe nausea or vomiting
- Confusion or significant changes in mental status
- Severe dehydration
- Persistent abdominal pain
- Symptoms of a kidney stone, including severe flank pain or blood in the urine
These symptoms may indicate significantly elevated calcium levels that require urgent treatment.
Comprehensive Evaluation
During your consultation, your surgeon will review your symptoms, laboratory results, imaging studies, and overall medical history to determine whether surgery is appropriate.
Your evaluation includes discussion of:
- When elevated calcium was first identified
- Previous calcium and PTH laboratory results
- History of kidney stones
- Bone density testing and fracture history
- Symptoms affecting daily activities
- Family history of endocrine disorders
- Previous neck surgery or radiation exposure
- Current medications, including calcium or vitamin D supplements
A focused examination of the neck is performed, although the abnormal parathyroid glands are usually too small to be felt during a physical examination.
Diagnosis & Risk Assessment
The diagnosis of hyperparathyroidism requires a combination of laboratory testing and imaging studies.
Blood Tests
Blood work is the cornerstone of diagnosis and typically includes:
- Calcium level
- Parathyroid hormone (PTH)
- Vitamin D
- Phosphorus
- Kidney function tests (creatinine and estimated GFR)
These results help confirm the diagnosis and determine whether elevated calcium is being caused by an overactive parathyroid gland.
Urine Testing
A 24-hour urine collection may be recommended to:
- Measure calcium excretion
- Assess kidney stone risk
- Distinguish hyperparathyroidism from other conditions affecting calcium metabolism
Bone Density Testing (DEXA Scan)
Because excess PTH gradually removes calcium from bones, a bone density scan helps evaluate:
- Osteopenia
- Osteoporosis
- Fracture risk
This information helps determine whether surgery is likely to improve long-term bone health.
Imaging Studies
Imaging is used to locate the abnormal gland before surgery and may include:
Neck Ultrasound
Ultrasound can identify enlarged parathyroid glands and evaluate the nearby thyroid gland for nodules or other abnormalities.
Sestamibi Scan
A nuclear medicine scan that helps locate overactive parathyroid tissue before surgery.
4D CT Scan
For patients with more complex anatomy or prior neck surgery, specialized CT imaging provides highly detailed information to assist with surgical planning.
Risk Assessment
Your surgeon considers several factors when determining whether surgery is appropriate, including:
- Degree of calcium elevation
- PTH level
- Kidney function
- History of kidney stones
- Bone density results
- Age
- Overall health
- Severity of symptoms
These factors help guide individualized treatment recommendations and determine the optimal timing for surgery.
Treatment & Management
Treatment depends on the cause of hyperparathyroidism, the severity of calcium elevation, and whether complications have developed.
Observation
Some patients with very mild disease may not require immediate surgery. Careful monitoring may include:
- Periodic blood calcium and PTH testing
- Kidney function monitoring
- Bone density testing
- Maintaining adequate hydration
- Avoiding medications that may further increase calcium levels
Observation is generally reserved for carefully selected patients who meet established clinical guidelines.
Medical Management
Medication does not cure primary hyperparathyroidism but may help manage symptoms or calcium levels in selected patients who are not surgical candidates. Your physician may also recommend optimizing vitamin D levels and monitoring bone health.
Parathyroid Surgery (Parathyroidectomy)
For most patients with primary hyperparathyroidism, surgery is the preferred treatment because it removes the source of excess hormone production.
During surgery, the abnormal parathyroid gland, or, in some cases, multiple abnormal glands, is removed while preserving the remaining healthy glands. Most procedures are performed through a small incision in the neck using minimally invasive techniques when appropriate.
Benefits of surgery may include:
- Normalization of calcium levels
- Reduced risk of future kidney stones
- Improvement in bone density
- Lower fracture risk
- Improved kidney function in selected patients
- Relief of fatigue, muscle weakness, and other symptoms for many patients
Your surgeon will discuss the expected benefits, potential risks, and recovery process before recommending surgery.
Recovery & Follow-Up
Many patients return home the same day after parathyroid surgery. Follow-up blood work confirms that calcium levels have normalized and helps ensure the remaining parathyroid glands are functioning appropriately.
Most patients experience only mild postoperative discomfort and return to normal daily activities within one to two weeks.
At The Medical Group of New Jersey, our surgeons provide individualized, evidence-based care for hyperparathyroidism, from diagnosis and surgical planning through recovery and long-term follow-up, helping patients restore healthy calcium balance and protect their bones, kidneys, and overall well-being.
Related Services & Internal Links
Schedule a General Surgery Consultation
If you’re experiencing persistent symptoms related to diverticular disease, acid reflux, gallbladder disease, a hernia, thyroid or parathyroid disorders, or another condition that may require surgical evaluation, the experienced general surgeons at The Medical Group of New Jersey are here to help.
Our team provides comprehensive evaluations, explains your treatment options, and develops a personalized care plan based on your diagnosis, overall health, and goals. Whenever appropriate, we offer advanced minimally invasive and robotic-assisted surgical techniques designed to reduce pain, shorten recovery, and help you return to your normal activities sooner.
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