Hyperparathyroidism

Also called Overactive parathyroid, High calcium

A high calcium level on a routine blood test, usually ignored. Bones, stones, abdominal moans and psychic groans is the old summary, and it holds up.

What it is

Overactivity of the parathyroid glands, four small glands behind the thyroid that control calcium. In the primary form, usually caused by a single benign growth on one gland, too much hormone raises the blood calcium.

It is common, particularly in women over 50, and it is frequently found by accident on a blood test and then not acted on. A persistently raised calcium is a finding that deserves working up rather than repeating indefinitely.

Untreated it pulls calcium out of the bones, causing osteoporosis and fractures, and deposits it in the kidneys, causing kidney stones and reduced kidney function.

The symptoms are famously vague and are almost always attributed to something else: tiredness, low mood, aches, poor concentration, constipation. Many people are told they have depression, fibromyalgia or simply ageing. The classic teaching phrase, bones, stones, abdominal moans and psychic groans, is old but genuinely useful.

Surgery to remove the overactive gland is curative in the great majority, is usually a day case, and frequently resolves symptoms people had stopped mentioning.

Secondary hyperparathyroidism is different: the glands are responding appropriately to low calcium or vitamin D, usually in chronic kidney disease, and is managed rather than operated on.

Signs you might notice

Often none, with a raised calcium found incidentally.

Tiredness, low mood, irritability, poor concentration and memory.

Aches in bones and muscles, and joint pain.

Constipation, nausea, indigestion, loss of appetite.

Excessive thirst and passing large amounts of urine.

Kidney stones, and fractures from minor injury.

Urgent, for very high calcium: confusion, drowsiness, vomiting, severe dehydration, or abnormal heart rhythm. This is a hypercalcaemic crisis and needs emergency treatment.

Any persistently raised calcium should have a parathyroid hormone level checked. That single test is what makes the diagnosis and it is regularly not done.

How it can affect day-to-day life

The commonest experience is years of feeling below par and being told the blood tests are essentially normal, because the calcium is only slightly high.

Symptoms are often only recognised in hindsight, after surgery, when people notice their concentration and mood have returned.

Dehydration raises calcium further, so illness, hot weather and diuretics can tip somebody over.

Thiazide diuretics and lithium both raise calcium and should be reviewed.

Vitamin D is often low alongside and, contrary to what people fear, usually needs correcting rather than avoiding, under specialist advice.

For older people, the same symptoms get attributed to dementia, and a treatable cause is missed.

Supporting someone well

Do not let a raised calcium sit unexplained. Ask for a parathyroid hormone level.

Ask for kidney function, a kidney ultrasound and a bone density scan; those determine whether surgery is indicated.

Keep well hydrated, and be careful in hot weather and during illness.

Ask about reviewing thiazide diuretics and lithium.

Ask about surgery rather than assuming monitoring is the only option; cure rates are high and it is usually a day case.

Ask specifically whether the tiredness, mood and concentration symptoms might be related; many people never connect them.

For anyone older with unexplained confusion, ask for calcium to be checked.

Where to get help

A GP practice for the blood tests, and endocrinology for assessment.

A specialist endocrine surgeon for parathyroid surgery; volume and experience matter.

999 or urgent care for confusion and vomiting with known high calcium.

Pituitary Foundation cover related endocrine conditions and support.