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The symptoms of parathyroid disease are often described as subtle or vague, which is why it can take years to obtain a correct diagnosis. Patients frequently visit their primary care doctors complaining of just feeling “old” or “off.” They might be treated for depression, menopause, or fibromyalgia before anyone checks their calcium levels. However, once the diagnosis is made, patients often look back and realize they have been suffering from a classic set of symptoms for a long time.
The causes of this condition are rooted in the biology of the gland cells. Inheritance, diet, and lifestyle usually do not cause it. It is a mechanical failure of the gland’s internal sensor. Comprehending the symptoms aids patients in linking their physical discomfort, mental confusion, and blood test results. This section breaks down the classic signs used by medical students for decades and the modern understanding of how this disease affects daily life.
For generations, medical students have been taught a rhyme to remember the symptoms of hyperparathyroidism: “Moans, Groans, Stones, and Bones.” This simple phrase captures the wide-reaching effects of high calcium in the blood.
“Moans” refers to the psychiatric and mental effects, like fatigue and depression. “Groans” refers to abdominal pain, causing issues like constipation or ulcers. “Stones” refers to the painful kidney stones that form when the kidneys try to filter out the excess calcium. “Bones” refers to the deep aches and pains in the limbs, as well as the thinning of the bone structure itself. Most patients have at least a few of these, even if they seem unrelated at first.
The physical toll of having high calcium is significant. Calcium acts as a sedative to the nerves. When levels are too high, the nerve signals travel slower. The result leads to generalized muscle weakness. Patients often say they feel like their legs are heavy or that walking up a flight of stairs feels like climbing a mountain.
Kidney stones are one of the most painful, obvious signs. The parathyroid hormone tells the body to dump calcium into the blood. The kidneys act as filters and try to get rid of this excess calcium through urine. When the concentration of calcium in the urine gets too high, it crystallizes into stones. Anyone with recurrent kidney stones should always have their parathyroid hormone and calcium levels checked.
Bone pain is another common physical complaint. The sensation is not typically joint pain like arthritis, but a deep, boring ache in the long bones of the arms and legs. It happens This is because the hormone actively stimulates cells called osteoclasts, which eat away at bone tissue to release calcium. Over time, this inflammation weakens the bones so much that they can break from minor bumps or falls, a condition known as pathologic fracture.
The mental impact of parathyroid disease is often the most debilitating but the hardest to explain. High calcium affects the electricity of the brain. Patients report a severe lack of energy that sleep does not fix. They wake up worn out and go to bed exhausted.
“Brain fog” is the term most patients use. It involves difficulty concentrating, forgetfulness, and an inability to focus on complex tasks. It can resemble attempting to navigate through a fog of confusion. Patients in high-pressure jobs may find they can no longer keep up, or they forget names and appointments.
Depression and irritability are also common. The high calcium levels alter the neurotransmitters in the brain. Patients may feel anxious or sad for no apparent reason. Family members often notice a change in personality, describing the patient as shorter-tempered or less interested in hobbies they used to enjoy. These symptoms often resolve remarkably fast once the harmful gland is removed.
High calcium levels also affect the gut. Calcium plays a role in the movement of the intestines. When levels are high, the smooth muscle of the gut slows down. This leads to chronic constipation that does not respond well to laxatives.
High calcium can also increase acid production in the stomach. This can lead to acid reflux (GERD) or even stomach ulcers. Patients often complain of vague abdominal pain or nausea. They may lose their appetite. These “groans” from the abdomen are a direct result of the chemical imbalance in the blood slowing down the digestive process.
The primary cause of this condition is a benign tumor called an adenoma. This happens when one cell in one of the four glands mutates. It loses its ability to sense the calcium outside. It thinks the calcium level is zero, even when it is high. As a result, the cell divides and grows, producing increasingly higher levels of hormone.
We do not know exactly why this mutation happens. It is usually random. It is not caused by stress or injury. In a small number of cases, it can be caused by radiation exposure to the neck, such as treatment for a childhood cancer. But for the vast majority, it is just unfortunate luck. The adenoma grows independently of the body’s needs, hijacking the calcium control system.
In about 80 to 85 percent of cases, the cause is a single harmful gland (adenoma). However, in some patients, all four glands grow and become overactive. This is called parathyroid hyperplasia.
Hyperplasia is more common in patients who have a genetic predisposition or those who have taken lithium for many years. It is also seen in patients with kidney failure (secondary hyperparathyroidism). Understanding whether you have one undesirable gland or four undesirable glands is important because it changes the surgical approach. With a single adenoma, the surgeon just takes one out. With hyperplasia, they might need to remove three and a half glands, leaving just a tiny piece behind to function.
Most people discussed here have “primary” hyperparathyroidism, meaning the problem started in the gland itself. However, there is also “secondary” hyperparathyroidism. This kind of condition happens when another problem, usually kidney failure or severe vitamin D deficiency, causes calcium to drop.
In these cases, the parathyroid glands are just doing their job. They grow large because they are trying to raise the calcium levels back to normal. The glands are not the antagonists in this scenario; rather, they are responding to a challenging situation. Surgery is usually not the first choice for secondary disease; fixing the vitamin D or kidney issue is the priority. However, if the condition lasts for years, the glands can become stuck in the “on” position, requiring surgery later (tertiary hyperparathyroidism).
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Primary hyperparathyroidism caused by a benign adenoma is the most common cause of high calcium in blood tests for people who are otherwise healthy.
No. Stress does not cause parathyroid tumors to grow. The tumors are caused by a random cellular mutation or occasionally by radiation exposure.
The severity of symptoms does not always match the number. You can feel terrible with a calcium level that is only slightly above normal because the body is very sensitive to even small changes in calcium electricity.
Almost never. Parathyroid cancer is incredibly rare. The tumor is benign, meaning it does not spread to other parts of the body, but it damages the body by releasing excess hormones.
No. You cannot fix a parathyroid tumor by changing your diet. Eating less calcium won’t stop the tumor, and eating more won’t help your bones because the hormone will just flush it out.
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