When one or more parathyroid glands are overactive, hyperparathyroidism results. The parathyroid glands are a group of four pea-sized structures behind the thyroid gland located in the neck. Even though they are anatomically extremely close to the thyroid, their functions have nothing at all to do with each other. The glands produce the parathyroid hormone which is responsible for the metabolism of mostly calcium, which is vital for the functioning of the muscular and nervous systems. When blood calcium levels are high in healthy individuals, parathyroid hormone levels it typically low, however, in hyperparathyroidism one or more of the glands produce excessive amounts of parathyroid hormone independent of the body’s calcium levels, which this hormone normally controls. As a result of the increased hormone production, inappropriately normal or excessive blood calcium leaks from the bones into the bloodstream, resulting in hyperparathyroidism symptoms. It could manifest as osteoporosis, kidney stones, weakness, etc. The risk of developing primary hyperparathyroidism is increased by radiation exposure. Multiple endocrine neoplasia (MEN) syndrome and other genetic disorders also raise the risk.
parathyroid glands
Types of hyperparathyroidism
The occurrence of a benign (non-cancerous) tumor in one of the parathyroid glands is the most frequent cause of excessive parathyroid hormone production. This is called primary hyperparathyroidism. 96% of individuals with primary hyperparathyroidism have this growth of one parathyroid gland, known as a parathyroid adenoma. It rarely turns cancerous, however, because it raises the blood’s calcium level, which can gradually destroy a variety of tissues, and it harms the body over time. The other percentage makes up secondary hyperparathyroidism. It is referred to as “secondary” because it arises from an issue with the body’s other organs rather than the parathyroid glands. It occurs as a result of vitamin D deficiency, kidney failure, or chronic kidney disease. According to Dr. Ben Lancashire an endocrine surgeon, the removal of the adenoma or hyperactive parathyroid glands is the only way to treat primary hyperparathyroidism while administration of vitamin D supplements or treatment of kidney disease takes care of secondary hyperparathyroidism.
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Common symptoms
Most people with primary hyperparathyroidism generally “feel well” or are asymptomatic. Only individuals without “obvious clinical sequelae” such as kidney stones, bone disease, or hypercalcemic crises are considered to be “asymptomatic,” which is a loosely defined term. They may have other symptoms like anxiety, depression, and neuromuscular problems that are not counted as “serious”. Usually, the problem is identified during blood work for other purposes. Symptoms of hypercalcemia are; muscle weakness and soreness, nausea and vomiting, decreased appetite, increased thirst and excessive urination, bone pain, osteoporosis cognitive impairment, and kidney stones. Hypovitaminosis D usually manifests as osteomalacia, rickets, and renal osteodystrophy.
Hyperparathyroidism and mental health
A study was carried out by a group of medical scientists at the University Hospital, Uppsala in Sweden to assess the occurrence of psychiatric symptoms among 441 patients with primary hyperparathyroidism who had surgery. Also the relationship between these symptoms and sex age, and level of hypercalcemia(elevated calcium levels). Follow-up questionnaires were distributed in a post-operative time frame of 4 to 27 years. Interestingly, psychiatric symptoms developed in 28% of the participants. The individuals with these symptoms were substantially older than the other patients, but they shared the same sex distribution and serum calcium levels. In senior patients, severe symptoms appeared more frequently. Similar symptoms were noticed in patients with mild to moderate hypercalcemia as well as those with very high serum calcium values. The most common symptoms were anxiety and depression, others were paranoia, psychosis with hallucination, organic brain syndrome, and minor cerebral impairment. According to this study, hyperparathyroidism patients frequently have psychological symptoms, which can happen even when there is just mild hypercalcemia. Those who are older appear to be more susceptible and more likely to experience severe symptoms like psychosis or organic brain dysfunction.
It has become increasingly clear how crucial the calcium ion is to the central nervous system’s regulation processes. Postsynaptic receptor sensitivity and the production of central neurotransmitters are calcium-dependent processes. Some people with hyperparathyroidism show aberrant EEG patterns and secondary hyperparathyroidism has been linked to higher calcium levels in the brain.
Coping strategies
The following lifestyle modifications and strategies can help prevent complications:
- Calcium monitoring: Calcium restriction in diet is very necessary for people living with hyperparathyroidism. Avoidance of medication that elevates calcium levels: Lithium and several diuretics, among other medicines, can cause calcium levels to rise. It is important to consult health personnel before taking any form of medicine including herbal medications and supplements.
- Liberal fluid intake: The consumption of plenty of fluids, especially water, is greatly encouraged. This reduces the chances of the development of kidney stones. The creation of a free flow of urine from the urinary tract prevents any stone formation. 6 to 8 glasses of water daily are sufficient. Avoidance of smoking: Smoking increases the risk of bone loss which could lead to fractures and bone pain. It can also increase the risk of having other serious health problems that could worsen the ongoing illness.
- Regular exercise: Strength training, along with regular exercise, supports strong bones. Moderate exercise of at least 30 minutes daily, 5 days a week is sufficient. All potential food allergens should be eliminated. Foods like soy, corn, wheat, preservatives, and food additives. The health care provider may want to do food sensitivity tests.
- Avoidance of carbonated beverages: Carbonated beverages are high in phosphates and this can take the calcium away from the bones causing osteoporosis and bone loss. Some herbs like Chaste tree extract and Dandelion leaf can be used to prevent bone loss due to hyperparathyroidism, although there are not many scientific trials on these.
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Emotional management and healthcare resources
It might be overwhelming to receive a rare disease diagnosis. As they come to terms with a new diagnosis, patients and their carers could face particular difficulties. Being overwhelmed by a variety of feelings and emotions is normal. There may be other things to consider including financial burdens and life adjustments to accommodate changing responsibilities. With the onset of diagnosis, frequently having access to healthcare may be a priority. Patients’ needs may alter over time as they learn to cope with this rare condition.
Financial resources
Patient Advocate Foundation: PAF assists those who are uninsured or underinsured and who have life-threatening or incapacitating illnesses with case management. Access to care, support with co-pays, assistance with social security disability claims, and assistance with insurance appeals are all included in the services. Patients can locate resources in a specific state using PAF’s national financial resource directory.
Good days: They help patients whose diseases have a special impact on their quality of life. Help might be provided with travel and medical expenses. Over the years, the status of the funds for any specific ailment may vary.
Managing Costs (National Cancer Insitute): They give information on the location of organizations and resources that give financial assistance and information to help patients and families manage the costs connected with cancer treatment and care.
Caregiver support
National Alliance for Caregiving: The organization collaborates with other caregiving associations and organizations to offer more resources to assist family caregivers in addressing and overcoming the difficulties of providing care for a loved one.
Centre for Parent Information and Resources: They help parents take an active part in their children’s education and development by offering information and resources and working with families of infants, toddlers, children, and youth with disabilities, ages birth to 26.
Family Voices: This connects to a nationwide network of family organizations that offer assistance to the friends and families of children and young people with unique medical needs.
Conclusion
Hyperparathyroidism involves the enlargement of the parathyroid glands leading to excessive blood calcium levels. It could be asymptomatic or manifest as bone pain, weakness, and even mental disturbances. Proper diagnosis and adequate management are necessary and prove useful.
References
Hyperparathyroidism: Causes, Complications, Symptoms, and Treatment (endocrineweb.com)
Psychiatric Symptomatology in Patients with Primary Hyperparathyroidism
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