An Integrative Approach to Hyperparathyroidism: Comprehensive Testing, Nutritional Recommendations, and Supplements

You have four tiny parathyroid glands found in your neck near the thyroid gland that produce parathyroid hormones to help regulate levels of calcium in your blood. Calcium is an important mineral that your body requires in the proper amounts for strong bones and teeth, cardiovascular health, nerve function, and blood clotting. When the parathyroid glands produce too much parathyroid hormone (PTH), hyperparathyroidism develops. 

Elevated levels of PTH can cause levels of calcium in your blood to build up too high, a condition known as hypercalcemia. This can contribute to symptoms like bone and joint pains, tiredness, weakness, poor appetite, increased urination, and confusion. If calcium levels stay too elevated over time, damage to organs like the kidneys can occur.

An integrative approach to hyperparathyroidism can help to manage symptoms and support an individual with recovery. An individualized plan often incorporates dietary approaches, prevention of vitamin D deficiency, and supplements to address symptoms.

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What is Hyperparathyroidism?

Hyperparathyroidism results from an excess of parathyroid hormone produced by the parathyroid glands. There are four small parathyroid glands located at the bottom of your neck around the back of your thyroid gland that produce PTH to help regulate calcium and phosphorus in your blood. 

Hyperparathyroidism develops when the parathyroid glands become overactive and produce too much PTH hormone. This signals the body to make more calcium available in the blood, so calcium is released from bones, absorbed more from the digestive tract, and retained and returned to the blood by the kidneys instead of excreting it in the urine.

In the US, around 100,000 people develop hyperparathyroidism each year. This condition is most common in postmenopausal women.

Depending on the cause of elevated PTH, hyperparathyroidism is characterized into three types: primary, secondary, and tertiary.

What is Primary Hyperparathyroidism?

Primary hyperparathyroidism occurs when the parathyroid glands themselves grow a tumor (adenoma) or become enlarged (hyperplasia). Usually, these tumors are benign or non-cancerous. This type of hyperparathyroidism is most common in women who are over 60.

What is Secondary Hyperparathyroidism?

In secondary hyperparathyroidism, the parathyroid glands are normal, but something outside of the glands is imbalanced so that calcium levels in the blood drop. This sends the message to the parathyroid glands that they should produce extra PTH to try to keep calcium levels stable.

The most common causes of secondary hyperparathyroidism are severely low levels of vitamin D in the blood and chronic kidney failure. Vitamin D helps maintain balanced calcium levels in the blood in part by signaling the digestive system to absorb calcium from your food. Your kidneys normally convert vitamin D into a form that your body can use, so in chronic kidney failure, less usable vitamin D may be produced, resulting in calcium levels dropping too low. Other causes of secondary hyperparathyroidism include severe calcium deficiencies that can result from certain intestinal surgeries or diseases. 

What is Tertiary Hyperparathyroidism?

When secondary hyperparathyroidism is ongoing for a long time, it can start to behave like primary hyperparathyroidism. Tertiary hyperparathyroidism develops when calcium and vitamin D are chronically low or vitamin D synthesis is chronically suppressed due to kidney disease. This causes all four parathyroid glands to grow and produce excess PTH, leading to elevated levels of calcium levels being released from the bones. In these cases, serious kidney disease may occur and require supportive treatment like dialysis.

Hyperparathyroidism Symptoms 

Some people experience few or no noticeable symptoms with hyperparathyroidism, while others can notice impacts. While some symptoms are related to the elevated levels of calcium that occur in this condition, others may not relate to the calcium blood levels. 

Some symptoms that can occur in people with hyperparathyroidism include: 

• Depression
• Fatigue
• Decreased thirst
• Decreased urination
• Loss of appetite
• Weak muscles
• Constipation
• Pain in the abdomen
• Difficulty concentrating and confusion

Symptoms Of Hypercalcemia

Abnormally high levels of calcium in the blood and urine can lead to organs and tissues becoming damaged. When calcium builds up in the body to too high levels, you may become nauseous and vomit, feel sleepy or confused, experience muscle spasms and bone and joint pain, have an irregular heartbeat, or develop high blood pressure (hypertension). 

If blood calcium levels are very elevated and/or remain elevated over time, further complications can develop, such as:

• Weak bones and fractures (osteoporosis)
• Kidney stones
• Kidney damage and failure 
• Stomach (peptic) ulcers
• Inflammation of the pancreas (pancreatitis)
• Life-threatening heart rhythm abnormalities
• Loss of consciousness or coma

Causes Of Primary Hyperparathyroidism

Most cases of primary hyperparathyroidism are caused by a benign tumor or adenoma which forms on one of the parathyroid glands that produce excess PTH. In other cases, two or more of the parathyroid glands become enlarged (hyperplasia) and produce increased levels of PTH. 

Much less frequently, primary hyperparathyroidism is caused by cancer of the parathyroid gland or multiple endocrine neoplasia type 1, a genetic condition that causes tumors in the parathyroid glands, pituitary gland, pancreas, and other parts of the digestive tract.

Low levels of vitamin D are common in people with primary hyperparathyroidism and can further stimulate the parathyroid glands to make even more PTH. 

Certain treatments can also trigger hyperparathyroidism. Radiation to the neck for other cancers can sometimes trigger hyperparathyroidism.

How is Hyperparathyroidism Diagnosed?

To avoid complications, it is important to accurately diagnose hyperparathyroidism early on. Hyperparathyroidism is diagnosed by testing the blood for elevated levels of PTH, elevated levels of calcium, and low levels of phosphorus.

Once a diagnosis is established, a 24-hour urine collection to measure calcium, phosphorus, and creatinine, a waste removed by the kidneys, can help to distinguish primary hyperparathyroidism from hyperparathyroidism caused by a kidney disorder. When a tumor or overgrowth is suspected, a sestamibi scan may be used to look for any growths on the parathyroid glands or enlargement of the gland(s).

Imaging studies like an X-ray, CT scan, or ultrasound can assess the kidneys to look for any calcium deposits or stones. At the same time, a DEXA scan can be used to measure the strength of the bones and detect any bone loss or softening.  

Functional Medicine Labs That Can Help Individualize Treatment for Hyperparathyroidism

Functional medicine laboratory testing can help uncover contributing factors and individualize a treatment plan for hyperparathyroidism. 

Parathyroid Hormone (PTH)

Parathyroid hormone can be measured in the blood as a single marker test to evaluate the functioning of the parathyroid glands.

Calcium

Calcium levels can be checked in the blood test as total calcium, which includes calcium that is both free and bound to other molecules, such as transfer proteins. 

Calcium can also be measured in the urine with a 24-hour collection test to aid in the diagnosis of hyperthyroidism, kidney function, and kidney stones.

Calcium can also be found as a part of different testing panels. Great Plains Laboratory offers a calcium and magnesium urine panel. Many labs offer comprehensive metabolic panels (CMPs), such as the CMP by BostonHeart Diagnostics, that includes kidney, liver, and blood sugar markers, as well as calcium and other markers. Lastly, micronutrient tests, such as the micronutrient test by Spectracell Laboratories, assess numerous vitamins and minerals, including calcium.

Vitamin D

Low vitamin D levels are common with hyperparathyroidism, and a severe deficiency of this vitamin can cause secondary hyperparathyroidism. You can test for vitamin D, as there are various options. Measuring both calcidiol (25-hydroxycholecalciferol), the storage form, and calcitriol (1,25-dihydroxycholecalciferol), the most active form within the cells into which calcidiol is converted in the kidney, can be helpful.

Kidney Function

Laboratory tests can be performed to determine the status of the kidneys and their functioning capability. This is done by measuring certain waste products like creatinine and nitrogen, levels of minerals like calcium and phosphorus, and proteins in the blood and/or urine. 

For example, Access Med Labs' Renal Function Panel measures electrolytes like potassium, chloride, and sodium, minerals like calcium and phosphorus, and other markers to assess kidney function such as carbon dioxide, urea (BUN), glucose, creatinine, albumin, BUN/Creatinine ratio, and eGFR in the blood.

Another option to assess renal function is Access Medical Labs' 24-hour Urine Microalbumin test which analyzes a urine sample for microalbumin, a marker used for early screening of renal disease in high-risk patients. 

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Conventional Treatment for Primary Hyperparathyroidism

In mild cases of hyperparathyroidism, where there are no or few mild symptoms and blood calcium levels are normal or only slightly elevated, treatment may not be enacted right away. Instead, blood levels of calcium may be monitored every six months, along with yearly assessments of kidney function and bone health. Medications like thiazide diuretics or lithium should be avoided since they can increase calcium levels in your blood.

Primary hyperparathyroidism is treated surgically to remove the parathyroid gland(s). In order to prepare for surgery, elevated calcium levels and any resulting complications are addressed. This often includes rehydration with IV fluids if you are dehydrated and/or short-term use of bisphosphonate medications to lower calcium levels to a stable level. Bisphosphonates like etidronate (Didronel®), alendronate (Fosamax®), zoledronic acid (Zometa®), and ibandronate (Boniva®) help to prevent the loss of calcium from the bones.

If someone is not a candidate for surgery due to frailty or other issues, a medication called cinacalcet may be used. This is a calcimimetic that tells the body to produce less PTH to help bring down calcium levels in the blood.

Conventional Treatment for Secondary Hyperparathyroidism

Treatment for secondary hyperparathyroidism targets the underlying cause. Most commonly, this involves supplementation with vitamin D to target low vitamin D levels. In other cases, a comprehensive approach to addressing underlying kidney disease is needed to address the cause of low calcium. Cinacalcet is also approved for treating secondary hyperparathyroidism by signaling the parathyroid glands to produce less PTH.

Conventional Treatment for Tertiary Hyperparathyroidism

Tertiary hyperparathyroidism is usually treated with surgery. 

Integrative Medicine Treatment for Hyperparathyroidism

While surgical intervention is needed in many cases of hyperparathyroidism, an integrative approach can complement conventional treatment and support the individual in reducing symptoms and promoting recovery. 

For example, an anti-inflammatory diet and regular weight-bearing exercises, and strength training can help keep your bones healthy and reduce your risk for cardiovascular disease. Staying hydrated and getting enough sleep is also important for allowing your body to heal during the treatment of hyperparathyroidism. Together, a team of conventional endocrinologists and surgeons can work alongside you and your integrative practitioners to develop the most effective individualized treatment plan for your individual needs. 

Nutrition and Dietary Modifications for Hyperparathyroidism 

People with hyperparathyroidism need to keep calcium levels balanced for bone strength, nerve function, and cardiovascular health. While it is often recommended to avoid a too high-calcium diet, healthy calcium-rich whole foods to incorporate in an anti-inflammatory diet include beans, almonds, blackstrap molasses, oats, tahini, prunes, apricots, sardines, and dark green leafy vegetables such as broccoli, kale, collards, and spinach. Since some forms of calcium are better absorbed in an acidic environment, try combining lemon juice with your greens or drinking fresh-squeezed orange juice (without added sugars) with calcium-rich foods. Around 1,000 milligrams (mg) of calcium a day is generally recommended for adults ages 19 to 50 and men aged 51 to 70 and up to 1,200 mg a day for women over 50 and men over 70, adjusted depending on an individual’s condition. 

Since low vitamin D levels often occur with and contribute to hyperparathyroidism, it is also important to maintain healthy vitamin D levels through sun exposure, diet, and potential supplementation. Good dietary sources of vitamin D include salmon, cod liver oil, tuna, sardines, beef liver, egg yolks, orange juice, dairy, plant milks, and cereals that are fortified with this vitamin. 600 international units (IUs) of vitamin D a day is recommended for people ages 1 to 70, and 800 IUs a day for adults ages 71 and older. Those with deficiencies may need higher levels of supplementation depending on individual needs. 

Since hyperparathyroidism can often contribute to dehydration, it is also important to drink plenty of water to stay well-hydrated and help the kidneys function properly. Depending on your individual needs, it is generally recommended to drink enough water to produce nearly clear urine to reduce the risk of kidney stones.

Supplements and Herbs for Hyperparathyroidism

Supplements and herbs can help address some of the symptoms and complications that can result from hyperparathyroidism.

Vitamin D

In addition to incorporating vitamin D-rich foods into your diet and getting safe sun exposure to stimulate the production of vitamin D, some people with significant deficiencies may require supplementation. In those without soy sensitivity, studies suggest that isoflavones may increase the body's utilization of vitamin D for enhanced bone health benefits.

Dandelion

Dandelion (Taraxacum officinale) leaf tincture contains a high mineral content that can help support the bones to prevent fractures and softening that can occur in hyperparathyroidism. Use under the supervision of a knowledgeable practitioner since it can interact with some medications like certain antibiotics and lithium and may cause an allergic reaction in people with sensitivities to ragweed. 

Chaste tree 

Chaste tree (Vitex agnus castus) has been used traditionally to support the parathyroid gland. It is important to work with a knowledgeable provider as this herb can have hormone effects and interact with medications. 

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Summary

Hyperparathyroidism occurs when one or more of the four pea-sized parathyroid glands produce too much parathyroid hormone. These glands are found in your neck behind the thyroid gland and help to regulate levels of calcium and phosphorus in the body. When too much PTH is produced, calcium levels in the blood can become elevated as more is released from the bones, more is absorbed in the intestines, and less is lost in the urine. This can lead to complications like bone fractures, kidney stones, and cardiovascular disease. 

In hyperparathyroidism, blood testing often reveals elevated levels of PTH and calcium. Vitamin D levels may also be low, and kidney function should be monitored. 

When the cause of hyperparathyroidism is due to a tumor (adenoma) or overgrowth (hyperplasia) of a gland(s), it is usually treated with surgery. Secondary hyperparathyroidism results from causes outside of the parathyroid glands that result in calcium levels dropping in the body, signaling the parathyroid glands to produce more PTH in an attempt to regulate calcium levels. This most commonly occurs due to chronic kidney disease or vitamin D deficiency. 

An integrative approach can complement conventional surgical or other treatments and support the individual in reducing symptoms and initiating recovery. An anti-inflammatory diet providing balanced calcium and vitamin D along with targeted supplementation to support bone health can help prevent complications like fractures and maintain a good quality of life.