Parathyroid conditions

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Diagnosis

In most cases, elevated calcium is found by blood tests ordered for other reasons. For example, routine blood work or testing to figure out the cause of symptoms of another condition. Your provider may diagnose hyperparathyroidism by ordering:


  • Blood tests
  • If blood test results show that you have high calcium levels in your blood, your health care provider will likely repeat the test. This repeated test can confirm the results after you haven't eaten for a period of time.

  • Many conditions can raise calcium levels. But your health care provider can diagnose hyperparathyroidism if blood tests show you also have high levels of parathyroid hormone.

  • Additional tests
  • After diagnosing primary hyperparathyroidism, your health care provider will likely order more tests. These can rule out possible conditions causing hyperparathyroidism, identify possible complications and determine the severity of the condition. These tests include:

  • Bone mineral density test. This test is done to see if you have developed osteoporosis. The most common test to measure bone mineral density is dual-energy X-ray absorptiometry (DEXA).

  • This test uses special X-ray devices to measure how many grams of calcium and other bone minerals are packed into a bone segment.

  • Urine test. A 24-hour collection of urine can provide information on how well your kidneys work and how much calcium is passed in your urine.

  • This test may help your provider determine the severity of hyperparathyroidism or diagnose a kidney disorder causing hyperparathyroidism. If a very low calcium level is found in the urine, this may mean it's a condition that doesn't need treatment.

  • Imaging tests of kidneys. Your provider may order an X-ray or other imaging tests of your abdomen to determine if you have kidney stones or other kidney problems.
  • Imaging tests before surgery
  • If your health care provider recommends surgery, one of these imaging tests may be used to locate the parathyroid gland or glands that are causing problems:

  • Sestamibi parathyroid scan. Sestamibi is a radioactive compound that is absorbed by overactive parathyroid glands. It can be detected by a scanner that detects radioactivity.

  • A healthy thyroid gland also absorbs sestamibi. To keep the thyroid absorption from blocking the view of the absorption in a parathyroid tumor (adenoma), you're also given radioactive iodine. This is only absorbed by the thyroid. Using this process, the thyroid image is digitally removed so it can't be seen.

  • Computerized tomography (CT) scanning may be combined with the sestamibi scan to improve detection of any problems with the parathyroid glands.

  • Ultrasound. Ultrasound uses sound waves to create images of your parathyroid glands and surrounding tissue.

  • A small device held against your skin (transducer) sends out high-pitched sound waves and records the sound wave echoes as they reflect off internal structures. A computer converts the echoes into images on a monitor.

Treatment

If you have mild hyperparathyroidism (no symptoms, blood calcium levels only slightly elevated), your healthcare provider may not choose to treat it right away. Instead, your provider will monitor your blood calcium levels (every six months), blood pressure (every six months), kidney function (every year), and bone density (every one to three years).


  • If your healthcare provider believes your hyperparathyroidism doesn’t need immediate treatment, be sure to:

  • Drink more water.
  • Keep active and get more exercise to keep your bones strong.
  • Don’t take thiazide diuretics or lithium because these drugs can increase the level of calcium in your blood.
  • Ask your provider if you need to take a vitamin D supplement if your vitamin D level is low.
  • If you have more severe hyperparathyroidism symptoms or have an enlarged parathyroid gland (or glands) or a growth on your parathyroid gland, your provider may recommend surgery to remove the overactive gland(s). Surgery by an experienced surgeon can cure hyperparathyroidism in about 95% of cases.

  • Medical management

  • Cinacalcet (Sensipar®) has been approved by the Food and Drug Administration for the treatment of secondary hyperparathyroidism. The drug works by signaling the parathyroid glands to produce less PTH. Although cinacalcet is intended for secondary hyperparathyroidism, some healthcare providers prescribe it for primary hyperparathyroidism.

  • Another medication type that is sometimes prescribed is bisphosphonates. These drugs help prevent loss of calcium from bones, which reduces the risk of fracture and osteoporosis. Examples of bisphosphonates include etidronate (Didronel®), alendronate (Fosamax®), zoledronic acid (Zometa®) and ibandronate (Boniva®).

  • If you're a woman and you’ve already gone through menopause and have signs of osteoporosis, your provider may prescribe hormone replacement therapy (HRT). HRT may help your bones retain calcium.