Your Parathyroid glands–how one or more of these can become a problem
We as thyroid patients spend so much time talking about the thyroid gland that many aren’t aware of four other little glands that share neighboring space with your thyroid—your PARATHYROID glands. So I present this information to further your education. ~Janie, hypothyroid patient and site creator
Parathyroid glands are teeny — close to the size of a very small bean or a grain of rice. here are usually two of these tiny glands, each on the backside of your thyroid. Those higher ones are caller superior parathyroid glands, and the lower ones are called inferior parathyroid glands.
What is the purpose of our parathyroid glands?
Even as tiny as these glands are, they play a big role in your health and well-being. How? By being the master regulator of the hormone and macronutrient calcium in your body via the parathyroid hormone (PTH). i.e. your parathyroid glands will make sure you have enough, or not too much, of calcium by either releasing the PTH hormone, or not releasing it. This will go on all day to maintain that delicate balance of “enough” calcium.
You have more calcium in your body than any other mineral, and it’s mostly stored in your bones and teeth—up to 99% of it, say a lot of sources. So it plays a key role in keeping both bones and teeth strong and thick. It can also be found in your tissues and blood.
Calcium aids in the following:
- the contraction of your muscles,
- the relaxation of your blood vessels
- the release of signaling by your neurotransmitters
- optimal nervous system functioning
- adequate blood clotting
- the secretion of insulin
- your heart’s health
- optimizing the job of your body’s enzymes and proteins
- helping Vitamin D to convert to calcitriol (the active form of D) in your kidneys
- maintenance of your magnesium levels
What is the most common way our parathyroid glands can go haywire?
Contrary to the majority of thyroid patients having hypothyroid, the most common parathyroid problem is HYPERparathyroidism, of which there are two main kinds:
- Primary hyperparathyroidism (pHPT): This is a situation where at least one of the four parathyroid glands, which are behind your thyroid and share share a similar blood supply and drainage with the thyroid, can decide to become a bit hyper, increasing in size like a tumor, to produce too much PTH, and cause your body’s blood calcium levels to go too high. Rising levels of calcium can eventually make your bones weak or painful, cause abnormal heart rhythm, create kidney stones, cause depression, fatigue, cramping and more. The calcium range is small, and it’s time to be suspicious when calcium falls in the upper area. What causes hyperparathyroid? There’s no definitive answer for many patients who discover they have this issue! But for other causes, there is suspicion that it can also be related to taking lithium or steroids. When all four glands are enlarged and hyper, this is called parathyroid hyperplasia.
To the right is a photo of the two parathyroid glands that were removed from a friend of mine. This is what happens when a doctor keeps saying “Let’s wait to see what happens”. Nope, she finally had to grab the bull by the horns and get a surgeon to get them out!
- Secondary hyperparathyroidism: This form can occur simply from your calcium levels going too low due to kidney disease/renal problems, which in turn causes the parathyroids to overproduce. Pancreatitis and small bowel disease can spur secondary hyperparathyroidism, as well, as can low Vitamin D. Secondary hyperparathyroidism is a condition in which a disease outside of the parathyroid glands causes all of the parathyroid glands to become enlarged and hyperactive.
How do labs help me figure out if I have hyperparathyroidism (pHPT)?
Three tests will help: 1) Total serum calcium, 2) ionized calcium, and 3) intact PTH.
If either calcium level is high and/or the parathyroid hormone (PTH) is high, and that includes even moderately high, you’ve got a problem! Even if your PTH is “normal” and your calcium is high, you may have hyperparathyroidism (pHPT).
Even if it’s in the normal range, someone can have pHPT. There needs to be a proportionate balance between the two levels. For example, if someone’s calcium is 9.3 (8.7-10.2) and the PTH is 43 (15-65), this would be a more accurate “normal” lab result that doesn’t indicate any issues. But on the other side of the coin, if someone’s calcium is 10.0 (8.7-10.2) and the PTH is 60 (15-65), this person could have hyperparathyroidism (pHPT). The PTH should be closer to 20.
There is also another recently recognized state called Normocalcemic Primary Hyperparathyroidism. It is when the blood parathyroid hormone (PTH) levels are higher than normal, but the blood calcium level is normal in patients who do not have secondary hyperparathyroidism disease. Patients can have blood calcium levels that are occasionally high. Many patients with Normocalcemic pHPT will go on to develop classic pHPT. However, not all patients will go on to develop classic pHPT, and in fact some never progress at all. This is mentioned here.
Another clue that one might have hyperparathyroidism is when phosphorus goes too high. (Others may have low levels, tho.)
Note that if your PTH is over 40, you shouldn’t see calcium levels higher than 10 when the range is 8.0-10.0. Here’s another way to evaluate your results.
What are symptoms of having hyperparathyroid?
Nearly everyone with this disease has symptoms, and you can have four or more of the following, or all of them. But since several below could be associated with hypothyroidism, it’s wise to also do the PTH and calcium lab test to confirm which symptoms go with what!
- pain in your joints or bones (causing you to be diagnosed with “fibromyalgia”)
- heart palpitations or fast heart rate
- brain fog, depression, lack of concentration, memories issues
- nervousness, irritability
- fatigue (a very common symptom, and you may get diagnosed with Chronic Fatigue Syndrome when you actually have HPT)
- loss of energy
- sleep problems
- cramping in your muscles
- kidney stones
- acid reflux
- Osteopenia or Osteoporosis
- labs which show a stressed liver
- rising blood pressure (common)
- low levels of Vitamin D
- strange reactions when you take Vit. D, such as heart racing and anxiety–this is common! <——-
What is done to treat hyperparathyroid?
At the beginning, drinking plenty of fluids may help lower the high calcium to some degree. Strength training can help bones. RFA aka Radiofrequency Ablation, is another option to explore.
For many, surgery is the only cure. There are several types: Bilateral Neck Exploration, Minimally invasive parathyroidectomy (MIP), and Minimially Invasive Radioguided Parathyroid (MIRP) surgery, to name a few. There are many ways in how parathyroid surgery is performed based on surgeon preference. When deciding on a surgeon, it’s important to remember that the type of technique used is far less important than the surgeon’s personal experience and success rate. Research has proven that the chance of being cured and of not having a complication after parathyroid surgery depends on the experience of the surgeon. Depending on how complex the situation, the operation may last as little as 20 minutes or as long as several hours.
Here’s the most popular facility to take care of a parathyroid problem, and it’s in Tampa, Florida USA: the Norman Parathyroid Center But there are others you can explore by doing an internet search.
But…here’s an article who says that Vitamin D supplementation can help lower high levels of PTH: https://www.vitamindcouncil.org/blog/vitamin-d-supplementation-in-primary-hyperparathyroidism-not-a-bad-idea/
What about HYPOparathyroidism (hPTH)?
This unfortunate and more rare outcome—when one has sluggish or no Parathyroid hormone (PTH)—is mostly caused by damage to the parathyroid during thyroid surgery or the use of RAI—radioactive iodine in the treatment of Grave’s disease or Thyroid Cancer. One will see calcium fall and phosphorus rise. Low magnesium can also cause a healthy parathyroid to produce less PTH, as can a body which has become too alkaline (the opposite of acidic), called alkalosis. The latter can be caused by hyperventilation or the excess of of bicarbonate (baking soda).
Symptoms that one of more your parathyroid is underproducing include:
- muscle spasms or cramps
- numbness in your face or hands
- tinging in fingers, toes or lips
- weakness, fatigue
- brittle fingernails
- dry hair; dry skin
- increased pain
- sleep issues
- depression, poor memory
- anxiety, nervousness, irritability
- heart issues
Treatment of hPTH includes supplementation with calcium and vitamin D, as well as avoiding phosphorus in foods.
Potential causes of hypoparathyroid: low magnesium levels, autoimmune attack of the parathyroids, surgery on the neck for any reason, neck radiation, hereditary hypoparathyroid.
What role does Vitamin D play in all this?
Vitamin D, along with the PTH, helps to increase your blood levels of calcium by promoting absorption of calcium from your small intestines and stomach. i.e calcium won’t be absorbed without that Vitamin D! But if your parathyroid becomes hyper, your Vitamin D can fall. So if you also have hypothyroidism, which also results in lowered Vitamin D levels due to low stomach acid, your Vit. D levels take a huge hit.
Check out Jacquie’s story of finally figuring out why she didn’t feel completely great on NDT—high calcium!
7 years ago I was diagnosed with hypothyroid and came to the STTM site to learn all I could. I have been taking NDT med’s ever since. Symptoms improved but never really felt well. My labs said “normal” as did ultrasounds, but nothing was found for my underlying continued problems that come with being hypothyroid.
Jump ahead 7 years later to Jan 2017, I felt the worst ever. I came back to the STTM site, thinking I could learn more or had missed something. I felt That NDT was not working or maybe the meds were re-formalized.
And here I found it—this page on parathyroid. I haven’t even heard of Parathyroid before. I read and went for blood tests, of which I had to fight for. There it was: Calcium and PTH sky high! Surgery for 3.5 glands were removed in June 2017. I feel better than I ever have in years! Hypothyroid in lower lab range, staying steady. If I hadn’t have come back to Stop the Thyroid Madness, I would have never found my illness! Seven years of misery solved with a click of a mouse to this site. Thank you for all you do! It saved my life.
Get your doctors to check calcium levels. My doctor says the next time a patient comes in and says ‘I don’t think my medication is working, he will check calcium levels. One more doctor educated ðŸ™‚ With all my gratitude. Jacquie.
Check out Gina’s story—six years of high calcium and she didn’t put the pieces together
A while back, I shared my story of finding wellness with NDT treatment for my hypothyroid. Well, since then, I had a lapse back into fatigue accompanied by some other worrisome symptoms. A recent DEXA scan showed my hip bones were in the osteopenia range. I thought, what in the world is causing this? I am active, my thyroid dosing is optimal…what the???
My doctor decided to look into problems related to my parathyroid gland as a cause. Before I even got my blood work back, I looked over my last 6 years of labs and to my horror, discovered that I had a high calcium level EVERY SINGLE TIME: a marker for parathyroid tumors and yet…as usual, these doctors missed it.
It all makes sense now. My constipation never really improved, not even on NDT and a gluten and dairy-free diet, still forgetful (another symptom) and then, the horrible bone pain and GERD. You are right: we ARE our best advocates. I immediately brought these lab numbers to the attention of my new doctor and will be scheduling soon for surgery to remove the parathyroid adenomas.
In the interim, I’ve upped my vitamin d to 4000 u daily and added 500 mg magnesium citrate, plus hydrating myself really well (high calcium levels cause dehydration–leading to constipation). It is very important to get the word out to others (particularly our older population affected by thyroid disease) that parathyroid is often one of the most OVERLOOKED ailments in the medical community! Thanks so much again for all the work you do to keep us empowered and informed. I do hope my story helps someone else.
*Read Barbara’s story of finding out she had a parathyroid problem
*Read comments after having parathyroid surgery.
* Here are photos of enlarged parathyroid glands, called adenomas.
* A great site to learn more is from the Norman Parathyroid Center.
* UCLA’s long distance surgery program information here.
* How to Choose a Parathyroid Surgeon: https://www.youtube.com/watch?v=BLLZ5FynWCw