When your blood calcium stays too high for too long, your body starts breaking down. Not from injury or illness you can see - but from inside. Your bones weaken. Your kidneys form stones. Your brain feels foggy. You’re tired all the time. And no one seems to know why. This isn’t depression. It’s not aging. It’s hyperparathyroidism.
What’s Really Going On Inside Your Body?
Four tiny glands, each about the size of a grain of rice, sit behind your thyroid in your neck. These are your parathyroid glands. Their job? Keep your calcium in balance. Too little calcium? They release more parathyroid hormone (PTH). Too much? They shut off. Simple. But when one of these glands goes rogue - usually because of a benign tumor called an adenoma - it keeps pumping out PTH no matter what your calcium level is. That’s primary hyperparathyroidism. It’s the most common type, making up 80-85% of cases. And it’s not rare. About 100,000 Americans are diagnosed each year. Women are three times more likely to get it than men. And African Americans have higher rates too. The result? Calcium in your blood climbs above 10.5 mg/dL. Normal is 8.5 to 10.2. Once it hits 11 or higher, your body starts paying the price.How High Calcium Steals From Your Bones
Your bones aren’t just scaffolding. They’re storage units for calcium. When your parathyroid glands overwork, they signal your bones to release calcium into your bloodstream. Osteoclasts - the cells that break down bone - go into overdrive. Over time, your bone density drops. Fast. DXA scans show people with untreated hyperparathyroidism lose 2-4% of bone density every year at the hip and spine. That’s not normal aging. That’s active erosion. After five years, you’re looking at a 10-20% loss. Fracture risk jumps by 30-50%. A simple fall can break a hip. A cough can crack a rib. And here’s the cruel twist: even if you’re taking calcium supplements or vitamin D, your bones won’t rebuild. The excess PTH keeps the system locked in destruction mode. It’s like having a faucet running full blast while trying to fill a bucket with a hole in the bottom.It’s Not Just Bones - Your Whole Body Suffers
High calcium doesn’t just hurt your skeleton. It messes with your brain, kidneys, stomach, and heart. - Brain fog: 65% of patients report trouble focusing, memory lapses, or feeling mentally slow. Many are misdiagnosed with depression or anxiety. - Kidney stones: Calcium builds up in the urinary tract. About 20% of people with hyperparathyroidism develop stones. After surgery, 92% see fewer or no more stones. - Fatigue: Constant exhaustion is the #1 complaint. Not from lack of sleep - from your body running on overload. - Stomach issues: Nausea, constipation, and loss of appetite are common. Some people lose weight without trying. - Heart rhythm problems: High calcium can affect electrical signals in the heart. Long-term, it raises risk of hypertension and arrhythmias. One patient on EndocrineWeb described it like this: “I thought I was just getting older. Then my calcium was 11.8 and PTH was 142. After surgery, it was like someone flipped a switch. I slept through the night for the first time in years.”How Is It Diagnosed?
Most people don’t feel symptoms until it’s advanced. That’s why routine blood work matters. The first clue? A high calcium level on a basic metabolic panel. But here’s the catch: if your PTH is normal or only slightly high, doctors might dismiss it. That’s a mistake. In true hyperparathyroidism, PTH is inappropriately normal or high. If your calcium is up and your PTH isn’t down, your glands aren’t working right. That’s the diagnosis. Confirming it takes two high calcium tests at least a week apart. No single test is enough. Doctors also check: - Vitamin D levels (low vitamin D can mimic or worsen the condition) - Kidney function (creatinine, eGFR) - Bone density scan (DXA) If those confirm it, imaging starts. A sestamibi scan finds the bad gland in 90% of cases. Ultrasound helps too. In complex cases, 4D-CT gives 95% accuracy.
Surgery: The Only Real Cure
Medication can help manage symptoms. Drugs like cinacalcet lower PTH, but they don’t fix the root problem. They’re mostly used for people who can’t have surgery. The only cure? Removing the faulty gland. That’s parathyroidectomy. - 85% of cases involve one bad gland (adenoma). Surgery removes just that one. Success rate: 95-98%. - 15% have multiple enlarged glands (hyperplasia). Surgeons remove 3.5 out of 4 glands. Success: 85-90%. - Less than 1% are cancerous. Requires more aggressive removal. Modern surgery is minimally invasive. Most patients go home the same day. The procedure takes 1-2 hours. Recovery? Most people feel better in 3-7 days. Post-op, your calcium can drop too low temporarily - that’s normal. You’ll need calcium supplements for a few weeks. But within a year, bone density starts climbing back up. Studies show 3-5% gain in the spine in the first year, 5-8% by year two.Who Needs Surgery?
Not everyone with high calcium needs an operation. But if you meet any of these criteria, surgery is strongly recommended:- Calcium more than 1 mg/dL above the upper limit of normal
- Kidney function below 60 mL/min (eGFR)
- Bone density T-score of -2.5 or worse (osteoporosis)
- Age under 50
- Kidney stones or recurrent urinary issues
- Significant symptoms like fatigue, brain fog, or bone pain
What Happens If You Don’t Operate?
Some doctors suggest “watch and wait.” But that’s risky. A Mayo Clinic study of 1,200 patients found those with calcium over 12 mg/dL for years had 22% persistent symptoms even after surgery - fatigue, brain fog, pain - because damage had already been done. Those with calcium under 11 mg/dL? Only 8% had lingering issues. The longer you wait, the more likely your bones will never fully recover. The more likely you’ll need a hip replacement. The more likely you’ll end up with kidney failure. One patient, diagnosed at 52 after seven years of misdiagnosis, said: “I thought I was just worn out. Turns out, my body was eating itself alive.”
What About Side Effects?
Fear of surgery is common. People worry about voice changes, scarring, or lifelong medication. The truth? In experienced hands, the risk of permanent voice damage is less than 1%. Temporary hoarseness happens in about 5-10% of cases and fades in weeks. Scarring is minimal - often just a 1-inch incision. Most people don’t need lifelong meds after surgery. About 35% of patients get temporary low calcium after surgery. That’s manageable with calcium and vitamin D pills for 2-8 weeks. It’s not a life sentence. It’s a recovery phase.What Comes After Surgery?
You’re not done when you leave the hospital. - Get your calcium checked at 4, 24, and 72 hours after surgery. - Take calcium and vitamin D as prescribed - even if you feel fine. - Get a DXA scan one year after surgery to track bone recovery. - Avoid thiazide diuretics (like hydrochlorothiazide) - they raise calcium. - Eat 1,200 mg of calcium daily from food or supplements. - Walk 30 minutes a day. Weight-bearing exercise rebuilds bone. If you had multigland disease, you’ll need annual calcium checks forever. There’s a 5-10% chance of recurrence. Single-gland removal? Only 2-3% risk.Why So Many People Are Still Undiagnosed
The average patient sees three doctors and waits 2-5 years before getting the right diagnosis. Why? - High calcium is often dismissed as “just a lab error.” - Fatigue and brain fog get labeled as stress or depression. - Doctors don’t always check PTH when calcium is high. - Many primary care providers aren’t trained to recognize it. If you’ve had unexplained fatigue, kidney stones, or bone pain - and your calcium has been high even once - ask for a PTH test. Don’t wait for symptoms to get worse.What’s New in 2025?
The field is moving fast. In early 2024, the FDA approved a new drug, etelcalcetide, for primary hyperparathyroidism. Early trials showed a 45% drop in PTH - much better than older drugs. It’s not a replacement for surgery, but it could help people who can’t have it. AI is improving scans. New software can analyze sestamibi images with 98% accuracy, cutting down false positives. That means fewer unnecessary surgeries. And more people are getting screened. Medicare now covers calcium tests for adults over 65. Detection rates jumped 18% after that change. The message is clear: hyperparathyroidism isn’t rare. It’s underdiagnosed. And it’s treatable - if you catch it early.Can hyperparathyroidism go away on its own?
No. Once a parathyroid gland becomes overactive due to an adenoma or hyperplasia, it won’t fix itself. The excess PTH production continues, and without treatment, calcium levels stay high, leading to worsening bone loss, kidney damage, and other complications. Surgery is the only way to permanently correct the problem.
Is hyperparathyroidism the same as osteoporosis?
No. Osteoporosis is a condition where bones become weak and brittle. Hyperparathyroidism is a hormonal disorder that causes high calcium, which then leads to bone loss - and that bone loss can result in osteoporosis. So hyperparathyroidism can cause osteoporosis, but not all osteoporosis comes from hyperparathyroidism. Treating the underlying hormone problem is key to reversing the damage.
Can vitamin D help treat hyperparathyroidism?
Vitamin D doesn’t cure hyperparathyroidism, but correcting a deficiency is critical before surgery. Low vitamin D can make PTH levels rise even higher, worsening bone loss. Doctors often give patients high-dose vitamin D (50,000 IU weekly) for 4-8 weeks before surgery to stabilize calcium levels. After surgery, vitamin D helps bones rebuild - but taking extra vitamin D without treating the gland problem can make high calcium worse.
Do I need surgery if I have no symptoms?
Yes, if you meet certain criteria. Even without symptoms, if your calcium is more than 1 mg/dL above normal, your bone density is low, your kidney function is declining, or you’re under 50, surgery is recommended. The damage from high calcium is silent but real. Waiting for symptoms to appear often means the damage is already done.
How long does it take to feel better after surgery?
Many patients notice improvements within days - less fatigue, clearer thinking, better sleep. Bone pain and kidney stone frequency drop within weeks. Full bone recovery takes 1-2 years. But most people report feeling like themselves again within 3 months. The faster you act, the faster you recover.
Can hyperparathyroidism come back after surgery?
Yes, but it’s rare. If only one gland was removed (single adenoma), recurrence is 2-3%. If multiple glands were affected and only part were removed, the risk rises to 5-10%. Lifelong annual calcium checks are recommended, especially if you had multigland disease. Most recurrences are caught early and can be treated with a second surgery.
