Disease of the Parathyroid Glands.
Hyperparathyroidism is the main disease of parathyroid glands. Hyperparathyroidism
is the over-production of parathyroid hormone (PTH) by one or more
parathyroid tumors. This parathyroid page discusses what happens to
your body when you have a
parathyroid tumor and develop hyperparathyroidism.
Disease is called "Hyperparathyroidism".
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is a disease of the parathyroid glands...Too much parathyroid hormone is
produced by an overactive parathyroid gland. This is called
= condition of too much parathyroid gland activity hyper = too much
parathyroid = parathyroid gland
ism = a disease or condition
"There is no other disease that is so
easily cured which has such a tremendous impact on a patient's
health and their quality of life"
occurs when one (or more) of the four parathyroid glands
grows into a tumor and behaves inappropriately by constantly making excess
parathyroid hormone. This award-winning video
explains hyperparathyroidism in 5 minutes... You will see
one of the parathyroid glands grow into a tumor and make too much
parathyroid hormone which goes to the bones and removes calcium from the
bones. This tumor has lost its control mechanism and makes large amounts of parathyroid hormone.
Thus, even when the blood calcium level is
high--when the parathyroids should not be making any hormone at all--one
of the glands keeps making hormone. Remember as you read about hyperparathyroidism on these pages,
it is a hormone problem secreted by a benign parathyroid tumor. It
is not a cancer problem, however it can increase the occurrence of other
cancers. If you think you have this problem, then download the CalciumPro
parathyroid app that was developed by Dr Norman and his team of
experts. It will tell you if you have a parathyroid tumor
risks you have, and what to do about it. It costs $5.99 which is
less than a co-pay--and the app is smarter than your doctor.
hyperparathyroidism makes people miserable within the first year or two
of having high blood calcium (see our page on symptoms).
Other times it can go 10 years without causing too much problems other
than fatigue, bad memory, kidney stones, and osteoporosis. But make
no mistake about it, hyperparathyroidism kills people--it just takes 20 or
so years to do so.
What Causes Excess Parathyroid
The most common cause of excess hormone production
(hyperparathyroidism) is the development of a benign tumor in one of the parathyroid glands.
This enlargement of one parathyroid gland is called a parathyroid adenoma which accounts for
about 94 percent of all patients with primary hyperparathyroidism (see chart
below). This out of control parathyroid gland is essentially never cancerous (less than one in
5000 is cancer---essentially all of them are benign tumors), however, it slowly causes damage to the body because it induces an abnormally high level of calcium in the blood which can slowly destroy a number of tissues. Parathyroid adenomas typically are much bigger than the normal
"grain-of-rice" parathyroid and will frequently be about the size of an
olive or grape.
Thus, the typical patient with hyperparathyroidism will be cured of the
disease when this "olive" size tumor is removed.
They will live just fine forever with their three remaining normal parathyroid glands that will be about the size of a grain of rice. The picture to the left is a picture of
a typical parathyroid adenoma (parathyroid tumor) that causes
hyperparathyroidism. This is a very average tumor size, shape, and color.
Most people with hyperparathyroidism will have a tumor in their neck about
this size. Remember, the normal parathyroid gland is about the size of a
grain of rice... but one cell inside this normal parathyroid gland went
out of control and started reproducing itself until a large tumor
developed. This tumor will almost always continue to grow until it is
removed. As it grows, it makes more hormone and will make you feel worse.
This tumor is constantly making parathyroid hormone which is what takes
the calcium out of your bones and makes the calcium in your blood too
high. (We have an entire page of photographs
of parathyroid tumors so you can see what these little boogers look
did this parathyroid tumor come from? This is a great question, and
the answer is quite simple... In most cases we don't know WHY
parathyroid tumors form. But this is HOW a parathyroid tumor
forms... The normal parathyroid gland is made up of about 80,000 very
small parathyroid cells. Each one is exposed to lots of blood flow and
they all measure the calcium in the blood. When the calcium is low, they
make parathyroid hormone (called PTH). When the calcium is high, they stop
making hormone. They normally turn on and off hundreds of times per day.
All of these cells act independent of the other. Occasionally, one of
these cells will go nuts and start reproducing itself... a million or more
times. The crazy "mother" cell divides into two, then does it
again, and again, and again; many times a day. Over a period of several
years a tumor develops. This tumor mass (seen in the photos on this site)
is made up of millions of cells all of which are sisters from one crazy
"mother" cell. Each of these "daughter" cells
inherited the craziness of the mom, and they don't pay attention to the
calcium level in the blood. They are out of control, making PTH whenever
they want, in as much concentration as they want. When you look at all the
pictures of the parathyroid tumors on this web site, you will see a small
(rice-size) yellow NORMAL gland with a dark-red tumor growing out of it.
The tumor mass is composed of millions of crazy daughter cells from one
mother cell that went nuts. If you have surgery at the Norman Parathyroid
Center, you will get a photo of your tumor, and you can almost always see
the normal gland from which the tumor arose.
graph shows the blood parathyroid hormone levels in 18,000 patients operated on at
the Norman Parathyroid Center for primary hyperparathyroidism. Normal
blood levels of parathyroid hormone vary according to the lab that
measures the hormone, but most labs have a normal level between 15 and 65
Each of the patients represented here had a parathyroid tumor removed from
their neck. As you can see, most (but not all!) of them have parathyroid
hormone levels that are above normal (above 65).
Note that most patients with primary hyperparathyroidism (due to a
benign tumor in their neck) have PTH
levels ranging from 50 to 150. When patients have PTH levels above 200 it
is because their tumor is very old (usually this means over 15 years
old) and the tumor is composed of MANY cells. If your PTH level is over
200, then some doctor somewhere was asleep at the wheel for at least
10 years. This should not
be allowed to happen, and the amount of destruction to your body is
generally worse. Also note that about 15% of patients that have a
parathyroid tumor in their neck will have PTH levels that are in the
"normal range". Let us say that again... about 15% of patients
with hyperparathyroidism will have high calcium levels and NORMAL PTH
levels. Realize that this is still hyperparathyroidism and they still have
a parathyroid tumor in their neck... We say their PTH level is
"inappropriately normal". In other words, it still shows that
there is a tumor full of crazy, out of control cells because if they were
normal parathyroid cells they would sense the high calcium and they
would shut down. If your calcium is high, and your PTH is not near zero (consistently
20 or below), then you almost certainly have a parathyroid tumor. GET IT
One final note... this graph shows Parathyroid Hormone (PTH) levels in patients with
primary hyperparathyroidism. This graph is DIFFERENT from the graph at the
bottom of our diagnosis page which shows CALCIUM
levels in patients with primary hyperparathyroidism. These graphs have the
same shape and thus you could confuse them... but one looks at the hormone
levels in the blood, and the other looks at the calcium level in the
blood. These two graphs are central to the diagnosis of
25% of patients with primary hyperparathyroidism who have two parathyroid adenomas while having two normal glands. This
is one of the reasons why parathyroid surgery is tricky--because some
people will have one tumor while others will have more than one. This is
why the most experienced (best) parathyroid surgeons will examine all four
parathyroid glands during the operation--so a second tumor is not left
behind. Surgeons who do lots of parathyroid surgery will not just take one
parathyroid tumor out and quit the operation, instead they will spend the
necessary time to make sure there isn't a second tumor (watch our surgery
video to see Dr Norman find a second tumor). The most common reason
that people have an unsuccessful parathyroid operation is because the
surgeon couldn't find the tumor. The second most common cause for people to have a failed
parathyroid operation is because they had two tumors and the surgeon
removed only one. We operate on an average of two people every day because
they went to an "expert parathyroid surgeon" who operated to
remove a tumor they saw on a scan, watched the hormone decrease by half,
and quit the operation without looking for a second tumor. Since at least
25% of people with hyperparathyroidism will have two parathyroid tumors,
then it is impossible for any surgeon to provide you with a long-term cure
rate (beyond 5 years) if they only look at one gland and quit the
operation. As you chose your surgeon, ask hard questions and be careful of
surgeons who claim to be experts, but will only look at one gland and
measure hormone levels. This does not take any expertise--any surgery
intern can do this operation.
An even rarer situation occurs in about 1.5 percent of all patients with primary hyperparathyroidism will have an enlargement of
all four parathyroid glands, a term called parathyroid hyperplasia. In this instance, all of the parathyroid glands become enlarged and produce too much parathyroid hormone. This is a much less common scenario but the end results
for the patient are identical.
a different page of this web site we discuss the importance of an experienced
parathyroid surgeon. Now you can see why experience is so
important--sometimes the disease is caused by one gland, sometimes two
glands, and sometimes four glands. Experience matters when operating on
parathyroid glands! One last word on parathyroid hyperplasia... it is
not very common. Unless you are on kidney dialysis or have taken lithium
for over 20 years, we can tell you the
the chance of you having parathyroid hyperplasia as the cause of your
hyperparathyroidism is less than 1%. Please do not dwell on this. It
makes no difference to you, nor does it make any difference to an
experienced surgeon. Please, we beg you, forget you ever heard the term
"4-gland hyperplasia"... you do NOT have this... so don't ask us
about it--it makes our eyes glaze over! But again, this is why you want
your surgeon to test all four glands--so you are cured and can feel better
(and live longer).
Does Too Much Parathyroid Hormone
and Calcium Cause Symptoms?
causes symptoms in almost everybody, but sometimes they are quite subtle.
We have put all of this information on a different page: Click here to
learn about Symptoms and dangers of Parathyroid Disease. It is important for you to understand these few
facts about blood calcium:
It is almost never normal to have a high calcium level in your
blood. Said differently, it is almost never for adults over 40 to have persistent calcium
levels of 10.1 or higher. See our page on "Normal
Levels According to Age", since many labs will show the upper
limit of normal for blood calcium up to 10.5 mg/dl--which is for
teenagers and not adults over 30.
Almost all patients with high calcium in the blood have one or two bad
parathyroid glands that is causing it. Your doctor may look for other
causes... but the overwhelming odds are that you will end up with parathyroid disease. We have an
entire page discussing the other even more
rare causes of high blood calcium on this web site, but don't
spend too much time there reading about things you don't have.
Persistent calcium levels over 10.1 (in an adult) is almost always a
The bad parathyroid gland(s) is a tumor. It is a benign tumor (not
cancer), but it is a tumor.
Most parathyroid tumors are between the size of peanut and a
grape. Occasionally they can be as big as a golf ball... or bigger.
However, the size of the tumor doesn't matter too much... just how much hormone it produces and how
much calcium it is taking out of your bones. We have photos
of these tumors on another page. If you have a big tumor, you are
the loser not the winner. These are slow growing tumors and if you
have a large one, it usually means your doctors have missed it for
An expert in parathyroid surgery can fix this problem in 20 minutes
or less. So if your surgeon says that it will take 2 or 3 hours in the
operating room... You may want to find an expert surgeon. If he says
it may take about 1.5 hours, then you may want to ask if it might take
longer--you can be assured that he will say "yes, it could take
as long as 4 hours or more". As
you will read on this site and every other web site (or book) ever
printed on the topic, picking your surgeon is the most important step,
since the outcomes (cure rates and complications) are directly related
to surgeon experience. There is no other area of the body that has
such variable anatomy.
Removing the bad parathyroid tumor will cure the hyperparathyroidism
and will make the calcium level go back to normal within hours.
It is almost unheard of for people to get parathyroid disease
(hyperparathyroidism) twice--if the surgeon did the operation
correctly the first time, analyzed all four parathyroid glands, and
carefully removed the tumor(s) by the root.. Said differently, surgery
disease, it is not a treatment for the disease. You should never get
this again if you have a surgeon who cures you the first time. If your
surgeon can't tell you that his/her cure rate for you will be 97% or
higher, then go somewhere else. If he/she says the cure rate will be
95% or better and he/she is only going to look at the one parathyroid
gland that shows on the scan, then know this is a fib. This isn't
possible. Our office is full of people who were told this.
Removing the parathyroid tumor will change the patient's life. It
often will make you feel 10 years younger, and literally, change your
life. Read about symptoms.Read testimonials from about 1500
Removing the parathyroid tumor will make you live longer
(statistically). From a statistical standpoint, patients with
hyperparathyroidism die an average of 5-6 years sooner than expected.
This is because the incidence of several cancers is increased by 1.8
to 3-fold (breast, colon, kidney, and prostate), the incidence of high
blood pressure is 2.5 times higher, stroke is 2 times higher, heart
disease is 2.5 times higher, atrial fibrillation (A-Fib) is 4 times
higher. This is all explained in more detail on
our Symptoms page, including
footnotes to medical journals. Thus, parathyroid tumors are benign
(not cancerous), but they slowly destroy your body, eventually making
you feel miserable, and increasing your chance of several cancers
dramatically. Do NOT "watch" your high calcium levels!
How Many People Get
The incidence of parathyroid disease (hyperparathyroidism) is 1 in 100 people in their
lifetime (1% of people).
This rate is much higher in women over 50 where the rate is 1 in 75 or
so. If you want to see how common this is, take a look at the map
of people we have operated on and you will see that we operated on a
neighbor of yours. All of you will know somebody with hyperparathyroidism. Unfortunately,
about 70% of
patients with hyperparathyroidism do not know they have it... they have
high calcium levels but their doctors don't know what this means and so
the high calcium is ignored. Often, when something bad happens (kidney
stones, bad osteoporosis, severe depression), then the doctors pay
attention to the high calcium. Hyperparathyroidism occurs in women more often than men
(almost exactly 75% women, 25% men), and the average age is about 59 years old--but people of any age can
get it. Young people do get parathyroid disease, but this is rare. We have
an entire page dedicated to this topic--Read about Who Gets It?
How Many Parathyroid
Glands are Bad?
everybody has 4 parathyroid glands, we could potentially get tumors in all
four glands. This is almost impossible, however, because the person would
be so sick that it would have been figured out sooner. Almost all people
with hyperparathyroidism have just one or two parathyroid tumors. In January, 2010 we published
that we operated on and cured for hyperparathyroidism to show average
calcium and PTH levels, and to show that a lot of people with
hyperparathyroidism don't have high PTH levels. In 2012 we
published another article on 16,500 patients in the Journal of the
American College of Surgeons showing that the only way to make sure a
patient is cured is if the surgeon looks at all four parathyroid glands.
Just taking out the one tumor shown on a scan will result in 20-25% of
people needing a second operation! Here is an update from January 2014
looking at our last 23,000 parathyroid operations, and the number of bad
parathyroid glands they had:
70.5 % = one enlarged, overactive gland (termed a single adenoma)
27 % = two or three large glands (termed multiple adenomas)
1.5 % = four enlarged, overactive glands (termed four-gland hyperplasia)
(this group is over-reported)
<<<1 % = cancer of the parathyroid (extremely rare). Do NOT
worry about parathyroid cancer!
most patients with hyperparathyroidism have 1 parathyroid tumor and
three normal parathyroid glands. Many of those patients with 4 bad
parathyroid glands (remember, only about 1.5% will have 4 bad
parathyroids) have 4 bad glands because they are 1) on the drug Lithium
for many years, or 2) have a parent and/or brothers/sisters with this
disease (called "familial hyperparathyroidism"). Thus, if you don't
have a parent with this disease and you have not been on the drug Lithium
for 20 or more years, then you have less than a 1% chance that you have 4
bad parathyroid glands. Bottom line, if your doctor thinks treating
hyperparathyroidism complex or complicated and dangerous, and tells you that you could
have 4 bad glands then you may want to take this page to them (or find a
different doctor because they are talking about something that they simply
don't know about).
Hyperparathyroidism can be cured quite easily if you chose a surgeon that
does this operation on a weekly basis (discussed on other pages of our web
site). Almost everybody with primary hyperparathyroidism can be cured in 20 minutes or less (we examine all four glands in almost every
one of our patients in less than 20 minutes). If your doctor or surgeon tells you that
surgery is dangerous and complicated... then you may want to find a surgeon that thinks it's
safe and simple. DO NOT let the concept of having one bad
gland versus 4 bad glands confuse you or influence your treatment! This is
one of our biggest pet peeves--the misunderstanding of 4-bad glands. You
do not have four bad glands! Please watch the movie of Dr Norman
performing a mini-4-gland parathyroid
operation--the entire operation takes less than 13 minutes and he
removes two parathyroid adenomas (when the scan only showed one), and
makes sure the other two glands are perfect. You will learn a lot by
watching this one simple video.
Essentially all patients with hyperparathyroidism will benefit from having surgery...
the only choice you really need to make is to choose your surgeon. Then
let the surgeon worry about 1 bad gland, 2 bad glands, or 4 bad
glands. As an example, the only difference in an operation for one
bad gland and 4 bad glands when we are performing the operation is that
those who have one bad gland have an operation that takes about 17
minutes on average, and operations for 4 bad glands takes about 17 minutes
on average. (HA! there is no difference!). Everything is exactly the same... same anesthesia, same
incision, same 1.5 hours in the recovery room... everything is the same.
Why are we spending so much time talking about this? Because this is a
very frequent worry that people have. They worry that they are one of the
1 percent of patients that have more than one bad gland... If you pick
your surgeon wisely, you will not have to worry about any of this because
your surgeon should check all four glands. If your surgeon isn't going to
check all four glands, THEN you should worry about not being cured--but
worry about a second adenoma being left behind (about 25% of the time),
don't worry about 4-gland hyperplasia (about 1% of the time). We don't
care how many parathyroid tumors you have--everybody at our center gets the same simple
operation to examine all four glands. That way we make sure we don't leave
a second (or third) tumor behind.
How the One Bad Parathyroid (the Adenoma)
Affects the Other Three.
To teach how the parathyroid glands respond normally to calcium
levels and how the parathyroid glands are supposed to work, we
will use your home's heating system in the winter as an example.
We all have a heater in our homes that is controlled by a thermostat.
When we set the thermostat on 70 degrees, it is this temperature that the
thermostat will constantly monitor and turn on the heater when the
temperature drops. If the temperature drops to about 68 degrees, the
thermostat detects it and turns on the heater. The heater warms the room
until the thermostat recognizes the increase in temperature, and when it
reaches 72 degrees the thermostat turns OFF the heater. In reality, the
heater in your home will turn on and off about 50 times per day. The
temperature in the room will vary some, from a little above 70 degrees to
a little below, but we don't notice it when the thermostat is working
All of our parathyroid glands have a built in "thermostat"
(all endocrine glands do!). The thermostat in the parathyroid glands is very sensitive to calcium levels in the blood. The normal 'setting' for
the thermostat in the parathyroid glands is for a calcium level between
8.5 and 10.2. Calcium is not just responsible for our bone strength,
but it is the source of electrical energy in our nervous system and
muscles, thus humans want this element controlled very, very well. Calcium
is the ONLY element in the body that has its own control system!
Normal parathyroid glands constantly monitor the calcium in the
blood. When the calcium levels drop, the parathyroid glands turn on...
and make parathyroid hormone (PTH). The PTH acts directly on the bones within
minutes and takes some calcium out of the bones (we use the bones as a
storage system for calcium). Now the level of calcium in the blood will
increase a little--and the parathyroid glands recognize this and turn
themselves off. Just like the thermostat that turned on when the
temperature got low, the normal parathyroid glands turned on when the
calcium got low. And, just like the thermostat that turned off when
the temperature in the room got warm, the normal parathyroid glands turn
off and stop making PTH when the calcium rose a little bit. This is why
your calcium will vary every time your doctor measures it... it's always a
little different, but it is always supposed to be in the normal range.
What happens in patients with Hyperparathyroidism? Well
that is now a simple answer. One of the parathyroid glands developed
a tumor. That tumor (an overgrowth of cells) will be about the size of an
olive (typically) and it will do what it likes to do...MAKE HORMONE! So,
you have this one big, bad parathyroid gland that is making hormone 24
hours per day... its thermostat is broken! It does NOT respond to
the high calcium levels and turn off...instead it is stuck in the "on
position", and constantly makes parathyroid hormone (PTH).
Well, this PTH keeps working on your bones, taking calcium out of the
bones and putting it in your blood. The bones become thin (osteoporosis),
and the calcium in the blood is elevated out of the normal range. We get
nervous system symptoms due to the brain not liking the high calcium
levels (depression, tiredness, mean-ness, lack of energy, problems
sleeping, etc). We can also get kidney stones and other problems due to
all the extra calcium floating around.
What happens to the NORMAL parathyroids when you have one bad
parathyroid gland? Well that answer is now clear also. In the
overwhelming majority of people with hyperparathyroidism, they will have one
bad gland and 3 normal glands. The one bad gland is big and producing PTH all day
long...making the calcium go high. Well, the three normal glands
will still have a normal thermostat. They will recognize the high calcium
and shut down their hormone making apparatus. Thus they become dormant and
go to sleep. Since most people with parathyroid disease don't get
diagnosed until they have had it for years--the normal parathyroid glands
will have been dormant for years by the time the surgeon operates to take
out the bad one. This is why experienced surgeons will provide their
patients with calcium pills to take for the first few weeks after
parathyroid surgery. It will take a week or two for the normal parathyroid
glands to wake up and begin to regulate the calcium normally (to get their
thermostats working properly). Without taking lots of calcium during that
time, your calcium can drop too low and you will get sick (have problems
with your nervous system and brain, like feel bad, feel 'foggy' and
confused, fell anxious and 'doomed', feel out of control; get tingling in
your hands and fingers and around your mouth, get cramps in your hands and
feet). These are all symptoms of LOW calcium, and they can happen
to patients after a successful parathyroid operation. The symptoms are temporary, and will go away after the nervous system gets used to the new
'normal' calcium levels. It may take 2 - 5 days, but these symptoms
will always go away, and they are always treated the same way--take more
calcium! If you get these symptoms after a parathyroid surgery--it
means the surgery was successful, but your body doesn't like the new
calcium levels yet and wants more calcium. You MUST give it more calcium
if you have these symptoms. (Please understand, 94% of people will NOT have
these symptoms as long as they take their calcium pills after the
surgery)... and the ones that do have symptoms of low calcium simply have
to take more calcium. (Note, these statistics come from our recent
publication where we studied this in 6000 consecutive patients who went
home within 1.5 hours of their operation. Of course, this is why all our
patients get our home phone and cell phone numbers).
Do I Really Need to Get this Parathyroid Tumor Removed?
The simple answer is this: yes. Having high calcium in your blood
is much more dangerous than having high cholesterol. Having high blood
calcium is more deadly than having thyroid cancer. In fact, having a
parathyroid tumor caries the same risk of early death as having diabetes. The high calcium
increases your risk of stroke, heart attack, and heart failure due to the
aggressive buildup of calcium in the arteries. The high calcium increases
the risk of developing several cancers by 2 to 3 times, including breast
cancer, colon cancer, kidney cancer and prostate cancer. Of course, the
high calcium came from the bones, so you will get osteoporosis and even
severe osteoporosis that cannot be treated with drugs--and your bones will
fracture. Of course, the high calcium makes you feel tired, increases your
blood pressure, makes you fatigued and takes away the joy of life. Read
more about the symptoms of hyperparathyroidism on our Symptoms
The good news is that hyperparathyroidism is a disease that is easily
cured. We don't "treat" hyperparathyroidism like you would
"treat" diabetes. Parathyroid problems are cured by simply
taking out the parathyroid tumor that is causing all the troubles. Once it
is out, the disease is cured and the risk of cancers, stroke, heart
attacks (etc) associated with untreated hyperparathyroidism will decrease.
Get the tumor out and put this behind you! Feel better, live longer--get
the darn tumor out of your neck!
is an educational service of the Norman Parathyroid Center,
the world's leading
parathyroid treatment center performing about 2600
parathyroid operations annually (over 50 per week).
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parathyroid diagnosis app for smart phones and tablets developed by our experts.