Key takeaways:
Parathyroid glands sit near your thyroid in your neck. They help control calcium levels in the blood.
Sometimes, parathyroid glands become overactive and produce too much parathyroid hormone (PTH). This is called hyperparathyroidism.
Many people with high PTH levels have no symptoms. When symptoms do occur, they can include fatigue, nausea, and constipation. Other symptoms are muscle weakness, kidney stones, and bone pain.
In most cases, surgery can cure hyperparathyroidism by removing an overactive parathyroid gland.
Most people have four small parathyroid glands in their neck, located near the thyroid. These glands don’t get much attention, but they play an important role in keeping your calcium levels balanced.
These glands do this by producing parathyroid hormone (PTH), which helps regulate how much calcium is in the blood.
If your PTH level is too high, it’s called hyperparathyroidism (HPT). This condition isn’t common: It affects less than 1% of people in the U.S.
In HPT, your body pulls calcium from your bones and into the bloodstream. This leads to high calcium levels (hypercalcemia), which can be dangerous. High calcium can affect many parts of the body, including your bones, heart, kidneys, and digestive system.
So, how do you know if you have a high PTH? Here’s what to watch for, along with what to do if you have symptoms.
What are the symptoms of a high parathyroid hormone level?
Most people with high PTH levels don’t have noticeable symptoms. Often, the first clue is a high calcium level on routine blood work.
But as parathyroid hormone and calcium levels increase, they can cause a number of signs and symptoms. These are sometimes summarized with a rhyming phrase: “bones, stones, moans, and abdominal groans.”
Symptoms may include:
General symptoms: fatigue, muscle weakness, and muscle aches
Bone-related symptoms: bone pain, fractures, and decreased bone density on a bone scan
Kidney symptoms: kidney stones
Mood symptoms: depressed mood, irritability, and sleep problems
Digestive symptoms: nausea, constipation
It’s important to note that these symptoms aren’t specific to HPT. They can overlap with many other conditions, which can make diagnosis challenging.
In fact, a study found that up to one-third of patients with high calcium or symptoms of HPT didn’t receive a diagnosis.
How is hyperparathyroidism diagnosed?
In many cases, hyperparathyroidism becomes a possible diagnosis when a routine blood test shows a high calcium level. This is often picked up on a comprehensive metabolic panel (CMP).
If you have a high calcium level, you can expect further testing. Your healthcare team will likely do the following:
Review your medical history and medications. Some medications can cause an increase in calcium.
They’ll also order another blood test to check your PTH and calcium levels together.
A high PTH level along with high calcium levels strongly suggest “primary” hyperparathyroidism — meaning the problem is coming from your parathyroid glands.
Additional tests may include:
Checking the calcium level in your urine, especially if your PTH results are borderline
Checking your vitamin D levels, since low vitamin D deficiency is common and can affect PTH levels
What does a high PTH level mean?
A high PTH level means it’s above the normal range for the lab that ran your test (often about 10 pg/mL to 65 pg/mL, depending on the lab).
What causes high parathyroid hormone levels?
To understand what your PTH level means and what’s causing it, your medical care team needs to consider your calcium level too:
Primary hyperparathyroidism: This means you have high PTH and high calcium. It’s usually caused by a benign (noncancerous) growth called an adenoma in one of the parathyroid glands. This causes the gland to become overactive and produce too much PTH.
Secondary hyperparathyroidism: This is high PTH due to low calcium. It often comes from kidney disease, vitamin D deficiency, or gastrointestinal diseases that cause low absorption of calcium from the diet.
This article focuses mainly on primary hyperparathyroidism.
What’s the best treatment for a high parathyroid hormone level?
The main treatment for primary hyperparathyroidism is surgery to remove the overactive parathyroid gland. The surgery is highly effective and can cure the condition in most cases (99%).
Surgery is typically recommended for primary hyperparathyroidism in these cases:
Your calcium levels are very high.
You have symptoms from high calcium levels.
You have complications from high calcium levels, like kidney stones or bone loss.
For people without symptoms and only mildly raised PTH levels, monitoring is an option. This involves regular blood tests and bone density checks.
What happens if you don’t treat hyperparathyroidism?
Without treatment, high calcium levels over time can lead to complications like:
Bone fractures
Osteoporosis (weakened bones)
Kidney stones
Kidney damage
It can also cause ongoing fatigue and mood symptoms.
In severe cases, very high calcium levels can be dangerous.
When should you get your parathyroid checked?
Anytime you’re struggling with symptoms that continue, get worse, or can’t be explained, don’t hesitate to get checked out. There are many causes for ongoing symptoms like:
Fatigue
Aches and pains
Mood changes
Nausea
These symptoms can be difficult to pin down. But simple blood tests can help point your healthcare team in the right direction. Routine care with a primary care provider can also help catch problems like high calcium early, even before symptoms develop.
Frequently asked questions
When treated, most people with hyperparathyroidism do well. Calcium and PTH levels remain stable or return to normal, and symptoms often improve. But there’s a risk of bone loss and kidney problems over time. This is especially true if you have a delay in diagnosis.
Yes. In most cases, removing the overactive parathyroid gland cures primary hyperparathyroidism. The remaining parathyroid glands continue to function normally.
When treated, most people with hyperparathyroidism do well. Calcium and PTH levels remain stable or return to normal, and symptoms often improve. But there’s a risk of bone loss and kidney problems over time. This is especially true if you have a delay in diagnosis.
Yes. In most cases, removing the overactive parathyroid gland cures primary hyperparathyroidism. The remaining parathyroid glands continue to function normally.
The bottom line
Most people with a high parathyroid hormone (PTH) level won’t feel any symptoms. When symptoms do occur, they’re often vague — like fatigue, aches, or mood changes. Often, the first clue is a high calcium level on routine blood work. If that happens, your healthcare team can run additional tests to confirm the diagnosis and determine next steps.
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References
El-Hajj Fuleihan, G., et al. (2022). Classical and nonclassical manifestations of primary hyperparathyroidism. Journal of Bone and Mineral Research.
Kulkarni, P. et al. (2023). Symptomatic versus asymptomatic primary hyperparathyroidism: A systematic review and meta-analysis. Journal of Clinical & Translational Endocrinology.
Lorenz, F. J., et al. (2022). Analysis of time to diagnosis and outcomes among adults with primary hyperparathyroidism. JAMA Network Open.
Pappachan, J. M., et al. (2023). Parathyroidectomy for adults with primary hyperparathyroidism. Cochrane Database of Systematic Reviews.
Parathyroid UK. (2024). Your parathyroid glands.
Press, D. M., et al. (2013). The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: A population-based analysis from the electronic medical record. Surgery.
