10 Common Symptoms of Hyperparathyroidism You Should Know

Hyperparathyroidism is a condition where one or more of your parathyroid glands become overactive, producing excessive amounts of parathyroid hormone (PTH). This hormonal imbalance leads to elevated calcium levels in your blood, a condition known as hypercalcemia. Understanding the symptoms of hyperparathyroidism is crucial for early detection and proper medical management.

When parathyroid hormone is high, it can affect multiple organ systems throughout your body, leading to a wide range of symptoms. Some people with mild hyperparathyroidism may experience no symptoms at all, while others face significant health challenges. The classic description of parathyroid disease symptoms is often remembered as “stones, bones, groans, and psychiatric overtones,” referring to kidney stones, bone problems, gastrointestinal complaints, and mental health issues.

Below are the 10 most common symptoms of hyperparathyroidism that you should be aware of:

1. Persistent Fatigue and Weakness

One of the most frequently reported symptoms of hyperparathyroidism is an overwhelming sense of fatigue that doesn’t improve with rest. This isn’t just ordinary tiredness—many patients describe it as a profound exhaustion that interferes with daily activities and quality of life.

The elevated calcium levels in your blood can affect cellular function throughout your body, leading to muscular weakness, particularly in the proximal muscles of your legs and arms. You may notice difficulty climbing stairs, getting up from a seated position, or lifting objects that previously seemed light. This weakness occurs because high PTH levels can cause muscle fibers to break down and calcium deposits to form in muscle tissue.

Many people with this symptom find themselves needing frequent naps or feeling unable to complete tasks that once required minimal effort. The fatigue can be so severe that it’s often mistaken for chronic fatigue syndrome, depression, or simply aging.

2. Bone Pain and Osteoporosis

When parathyroid hormone is high, it signals your bones to release calcium into your bloodstream. Over time, this constant calcium extraction weakens your bone structure, leading to bone pain, tenderness, and increased fracture risk.

Patients often experience:

• Generalized bone and joint pain, especially in the back, hips, and legs
• Increased susceptibility to fractures, even from minor falls or impacts
• Development of osteoporosis or osteopenia at an earlier age than expected
• A condition called osteitis fibrosa cystica in severe cases, where bone tissue is replaced by fibrous tissue

The bone pain associated with hyperparathyroidism can be constant or intermittent and may worsen with physical activity. Some patients describe it as a deep, aching sensation that seems to come from within the bones themselves. Bone density scans often reveal significant bone loss, particularly in the spine, hips, and forearms.

3. Kidney Stones

Kidney stones are one of the hallmark symptoms of parathyroid disease, occurring in approximately 15-20% of people with hyperparathyroidism. The excessive calcium in your blood must be filtered by your kidneys, and when calcium levels remain elevated, it can crystallize and form stones.

Symptoms of kidney stones related to hyperparathyroidism include:

• Severe, sudden pain in your back, side, lower abdomen, or groin (renal colic)
• Blood in your urine (hematuria)
• Frequent urination or urgent need to urinate
• Pain or burning sensation during urination
• Cloudy or foul-smelling urine
• Nausea and vomiting during stone episodes

People with hyperparathyroidism may experience recurrent kidney stones, meaning stones form repeatedly even after treatment. This pattern of recurring kidney stones, especially in younger individuals, should prompt evaluation for parathyroid disease.

4. Cognitive Dysfunction and Memory Problems

Elevated calcium levels can significantly impact brain function, leading to what many patients describe as “brain fog.” This cognitive dysfunction is one of the more distressing symptoms of hyperparathyroidism because it can affect work performance, relationships, and overall quality of life.

Common cognitive symptoms include:

• Difficulty concentrating or maintaining focus on tasks
• Short-term memory problems and forgetfulness
• Confusion or difficulty processing information
• Slower thinking or mental processing speed
• Difficulty finding the right words during conversation

These cognitive changes occur because calcium plays a crucial role in neurotransmitter function and neuronal signaling. When calcium levels are too high, it disrupts normal brain chemistry and electrical activity. Many patients report that these symptoms significantly improve after their hyperparathyroidism is properly managed.

5. Depression and Anxiety

The psychological impact of hyperparathyroidism is substantial, with many patients experiencing mood changes before any physical symptoms become apparent. The “psychiatric overtones” mentioned in the classic description of parathyroid symptoms reflect the significant emotional and mental health effects of this condition.

Mental health symptoms may include:

• Persistent feelings of sadness, hopelessness, or depression
• Increased anxiety, worry, or panic attacks
• Irritability and mood swings
• Loss of interest in activities once enjoyed
• Social withdrawal
• In severe cases, psychosis or severe psychiatric disturbances

These psychological symptoms can be particularly challenging because they’re often attributed to primary mental health disorders rather than recognized as manifestations of parathyroid disease. The exact mechanism isn’t fully understood, but elevated calcium levels appear to affect neurotransmitter balance and brain chemistry in ways that influence mood and emotional regulation.

6. Gastrointestinal Problems

The “groans” in the classic symptom description refer to the various gastrointestinal complaints that frequently accompany hyperparathyroidism. High calcium levels can affect the digestive system in multiple ways, leading to uncomfortable and sometimes debilitating symptoms.

Common gastrointestinal symptoms include:

• Nausea and vomiting
• Loss of appetite and unintended weight loss
• Constipation that doesn’t respond well to typical remedies
• Abdominal pain or discomfort
• Heartburn and acid reflux
• Peptic ulcers (in some cases)
• Pancreatitis (in severe cases)

The elevated calcium can slow down gastrointestinal motility, leading to constipation and feelings of fullness. It can also stimulate excessive gastric acid production, contributing to ulcers and reflux symptoms. Some patients report that these digestive issues were among their first noticeable symptoms of hyperparathyroidism.

7. Excessive Thirst and Frequent Urination

When calcium levels are high, your kidneys work overtime to filter the excess calcium from your blood, leading to increased urine production. This creates a cycle of excessive thirst (polydipsia) and frequent urination (polyuria) that can significantly impact daily life.

Patients typically experience:

• Constant feeling of thirst that’s difficult to quench
• Need to urinate frequently throughout the day and night
• Large volumes of urine production
• Disrupted sleep due to nighttime urination (nocturia)
• Risk of dehydration if fluid intake doesn’t match output

This symptom occurs because high calcium levels interfere with the kidney’s ability to concentrate urine. The kidneys produce more dilute urine in larger quantities, leading to increased fluid loss. Some patients report urinating every hour or waking multiple times each night to use the bathroom, which contributes to fatigue and reduced quality of life.

8. High Blood Pressure

Hyperparathyroidism is associated with an increased risk of hypertension (high blood pressure). Studies show that people with parathyroid disease have higher rates of high blood pressure compared to the general population, and the elevated PTH levels appear to play a direct role in this association.

The connection between hyperparathyroidism and blood pressure involves several mechanisms:

• Excess PTH may cause blood vessels to constrict, increasing vascular resistance
• High calcium levels can affect the smooth muscle in artery walls
• The condition may promote inflammation and changes in vascular structure
• Kidney involvement may contribute to blood pressure regulation problems

Many patients with hyperparathyroidism struggle to control their blood pressure with medication alone. The hypertension may be resistant to standard treatments until the underlying parathyroid problem is addressed. If you have difficult-to-control high blood pressure, especially in combination with other symptoms on this list, screening for hyperparathyroidism may be warranted.

9. Heart Palpitations and Cardiovascular Symptoms

Calcium is essential for normal heart rhythm and muscle contraction, so when calcium levels are abnormally high, it can disrupt cardiac function. Many people with hyperparathyroidism experience various cardiovascular symptoms that can be frightening and uncomfortable.

Cardiac manifestations may include:

• Heart palpitations or the sensation that your heart is racing, pounding, or skipping beats
• Irregular heartbeat (arrhythmias)
• Chest discomfort or tightness
• Shortened QT interval on electrocardiogram (ECG)
• Increased risk of calcification in heart valves and blood vessels
• Left ventricular hypertrophy (thickening of the heart muscle)

The elevated calcium affects the electrical conduction system of the heart and can alter how heart muscle cells contract. While these symptoms can mimic other cardiac conditions, they’re directly related to the hypercalcemia caused by excessive parathyroid hormone. It’s important to note that hyperparathyroidism is associated with increased cardiovascular mortality if left untreated.

10. General Body Aches and Joint Pain

Beyond specific bone pain, many people with hyperparathyroidism experience widespread musculoskeletal discomfort that can be difficult to pinpoint. This generalized achiness affects muscles, joints, and connective tissues throughout the body.

Patients commonly report:

• Diffuse muscle aches similar to flu-like symptoms
• Joint stiffness, particularly in the morning
• Pseudogout (calcium crystal deposition in joints) causing sudden, severe joint pain and swelling
• Arthritis-like symptoms in multiple joints
• Tenderness when pressure is applied to bones or joints
• Reduced range of motion and flexibility

This symptom is often misattributed to fibromyalgia, arthritis, or general aging, especially since it can be vague and non-specific. The calcium deposits that can form in and around joints contribute to inflammation and pain. Some patients also develop chondrocalcinosis, where calcium deposits accumulate in cartilage, leading to joint symptoms that resemble osteoarthritis or rheumatoid arthritis.

Main Causes of Hyperparathyroidism

Understanding what causes hyperparathyroidism can help you recognize risk factors and seek appropriate medical evaluation. There are several primary causes of this condition:

Primary Hyperparathyroidism

Parathyroid Adenoma: This is the most common cause, accounting for approximately 80-85% of cases. A benign tumor develops on one of the four parathyroid glands, causing it to become overactive and produce excessive PTH independent of calcium levels.

Parathyroid Hyperplasia: In about 15% of cases, all four parathyroid glands become enlarged and overactive. This can occur sporadically or as part of genetic syndromes such as Multiple Endocrine Neoplasia (MEN) types 1 and 2.

Parathyroid Carcinoma: This is a rare cause, occurring in less than 1% of cases. It involves a malignant tumor of the parathyroid gland that produces excessive PTH.

Secondary Hyperparathyroidism

Chronic Kidney Disease: When kidneys fail to properly activate vitamin D or eliminate phosphate, calcium levels drop, causing the parathyroid glands to work harder and eventually become overactive in compensation.

Severe Vitamin D Deficiency: Vitamin D is essential for calcium absorption. When levels are severely low over extended periods, the parathyroid glands increase PTH production to maintain blood calcium levels, which can lead to gland enlargement.

Malabsorption Disorders: Conditions that prevent proper calcium absorption from the diet, such as celiac disease, Crohn’s disease, or gastric bypass surgery, can trigger compensatory parathyroid overactivity.

Tertiary Hyperparathyroidism

This occurs when secondary hyperparathyroidism persists for so long that the parathyroid glands become autonomously overactive and continue producing excessive PTH even after the initial cause is corrected.

Risk Factors

• Age: Primary hyperparathyroidism is most common in people over 50 years old
• Gender: Women, particularly postmenopausal women, are at higher risk
• Radiation exposure: Previous radiation therapy to the head and neck increases risk
• Genetic factors: Family history of hyperparathyroidism or related endocrine disorders
• Certain medications: Long-term use of lithium can increase parathyroid activity
• Prolonged severe calcium or vitamin D deficiency

Frequently Asked Questions

What happens if parathyroid hormone is high?

When parathyroid hormone (PTH) is high, it causes your bones to release calcium into your bloodstream, leading to elevated blood calcium levels (hypercalcemia). This affects multiple body systems, potentially causing kidney stones, bone loss, fatigue, cognitive problems, mood changes, digestive issues, and cardiovascular symptoms. The severity of effects depends on how high the PTH levels are and how long the condition persists.

Can hyperparathyroidism go away on its own?

Primary hyperparathyroidism typically does not resolve on its own because it’s usually caused by a benign tumor (adenoma) or gland enlargement that continues to produce excessive hormone. However, secondary hyperparathyroidism may improve if the underlying cause (such as vitamin D deficiency or kidney disease) is addressed. Medical evaluation is essential to determine the type and appropriate management approach.

Is hyperparathyroidism serious?

Yes, hyperparathyroidism can be serious if left untreated. Over time, it can lead to significant complications including severe osteoporosis with increased fracture risk, kidney stones and kidney damage, cardiovascular problems, peptic ulcers, pancreatitis, and severely impaired quality of life. However, when properly diagnosed and managed, most people with hyperparathyroidism can achieve good outcomes and symptom relief.

How is hyperparathyroidism diagnosed?

Hyperparathyroidism is diagnosed through blood tests that show elevated calcium levels along with elevated or inappropriately normal PTH levels. Additional tests may include vitamin D levels, kidney function tests, urine calcium measurement, bone density scans, kidney imaging to check for stones, and imaging studies of the parathyroid glands (ultrasound or sestamibi scan) to locate the overactive gland(s).

At what age does hyperparathyroidism typically occur?

Primary hyperparathyroidism is most common in people over 50 years old, with peak incidence in the sixth and seventh decades of life. However, it can occur at any age, including in children and young adults, particularly in those with genetic predispositions. Women are 2-3 times more likely to develop the condition than men, with risk increasing significantly after menopause.

Can you have hyperparathyroidism with normal calcium levels?

Yes, this is called normocalcemic hyperparathyroidism. In this variant, PTH levels are elevated while calcium levels remain in the normal range. This may represent an early or mild form of the disease. It’s important to rule out secondary causes of elevated PTH (such as vitamin D deficiency or kidney disease) before diagnosing normocalcemic primary hyperparathyroidism.

What is the difference between primary, secondary, and tertiary hyperparathyroidism?

Primary hyperparathyroidism occurs when one or more parathyroid glands become overactive due to a problem in the glands themselves (adenoma, hyperplasia, or carcinoma), causing high PTH and high calcium. Secondary hyperparathyroidism is a compensatory response to low calcium levels caused by conditions like kidney disease or vitamin D deficiency; PTH is high but calcium is typically low or normal. Tertiary hyperparathyroidism develops when secondary hyperparathyroidism continues so long that the glands become autonomously overactive, producing high PTH and high calcium even after the original cause is treated.

Should I avoid calcium in my diet if I have hyperparathyroidism?

No, you should not severely restrict calcium intake if you have hyperparathyroidism. Contrary to intuition, adequate dietary calcium is important. Severe calcium restriction can actually worsen the condition by stimulating even more PTH production. However, you should avoid excessive calcium supplementation and discuss appropriate dietary calcium intake with your healthcare provider. The elevated blood calcium comes from your bones, not primarily from your diet.

References:

• Mayo Clinic – Hyperparathyroidism
• National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
• Johns Hopkins Medicine – Hyperparathyroidism
• National Center for Biotechnology Information (NCBI) – Hyperparathyroidism
• Endocrine Society – Hyperparathyroidism