Serious Disorder Often Missed in Women Over 65

Are these tiny glands causing you problems?
Serious Disorder Often Missed in Women Over 65

If you’re female and 65 or older, you may be overproducing parathyroid hormone (PTH).  Older women are twice as likely as older men to develop this problem.

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Too often, however, the condition — primary hyperparathyroidism (PHPT) — isn’t diagnosed.

That’s because PHPT often causes no symptoms. Or when symptoms such as muscle weakness, impaired memory, depression, or bone and joint pains do appear, they are often attributed to other problems.

“PHPT is at least eight times more common than previously reported,” says Joyce Shin, MD, who participated in a study on the subject.

Why worry about a seemingly obscure condition? Because it spikes your risk of:

Tiny yet powerful

The four parathyroid glands in your neck can be as small as grains of rice. Yet your muscles and nervous system rely on them to function smoothly.

These glands regulate blood calcium levels 24/7. When calcium levels drop, your parathyroids secrete more PTH to bring them back up.

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When your glands make too much PTH, however, blood calcium levels soar and remain high.

Three problems can trigger this overproduction:

  1. Adenoma: A benign growth on one or more glands
  2. Hyperplasia: Enlargement of two or more glands
  3. Cancer: Malignant tumors develop in rare cases

In addition, some people can inherit a gene that causes PHPT.

Cleveland Clinic study

Cleveland Clinic endocrine surgeons reviewed the medical records of more than 7,000 patients to see how often at-risk patients were evaluated for PHPT. They looked for patients with persistently high blood calcium levels plus a related condition such as:

  • Kidney stones
  • Osteopenia (bone thinning)
  • Osteoporosis
  • Depression

“We determined that 43 percent of our study population had undiagnosed or unrecognized PHPT,” says Dr. Shin. “Even in patients with biochemical studies that were consistent with PHPT, the diagnosis was not always documented, nor were they referred for surgical treatment.”

Patients with high blood calcium levels should have follow-up testing for PTH and vitamin D levels, she adds. Together, the three tests can confirm the diagnosis of PHPT.

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Dr. Shin and her colleagues recommend that hospitals set up automatic prompts in patients’ electronic medical records for PTH testing when blood calcium levels remain high.

The cure: Surgery

Since no medications can cure PHPT, surgery is necessary.

“Taking the affected parathyroid gland(s) out almost always cures the problem,” says Dr. Shin. One or more glands are removed. The gland or glands remaining in the neck keep regulating calcium.

“In a good surgeon’s hands, the risk of complications is minimal and the benefits are positive,” she adds. “For example, surgical cure can mean kidney stones are unlikely to recur.”

Calcium and vitamin D deficiencies can also trigger secondary hyperparathyroidism. So it’s important to get enough of  these key vitamins.

“I recommend calcium supplementation for patients who feel they are not getting enough in their diet, and 2,000 units of vitamin D daily as a maintenance dose,” says Dr. Shin.

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