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Health condition · Clinically reviewed

Hyperparathyroidism, primary, secondary and tertiary - modern diagnosis and surgery.

Hyperparathyroidism means one or more parathyroid glands (four small glands in the neck) are working too hard. That pushes calcium out of your bones and into your blood. In most primary cases, a short keyhole operation cures it - once a Sestamibi scan has shown which gland is to blame.

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Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Every claim is checked against NICE, BAETS or peer-reviewed sources you can see at the end.

  • 03

    Current for 2026

    Reflects UK and European guidance on Sestamibi localisation and minimally-invasive parathyroidectomy.

Key facts

Hyperparathyroidism at a glance.

The essentials, in plain English. What it is, what causes it, how it is found, and how it is treated in the UK today.

  • What it is

    Blood tests show high parathyroid hormone (PTH) and high calcium. The glands are overactive. Calcium leaks from your bones into your bloodstream.

  • Most common cause

    A single benign (non-cancerous) parathyroid adenoma. This causes about 85% of primary hyperparathyroidism.

  • Secondary and tertiary

    Secondary is caused by chronic kidney failure or low vitamin D. Tertiary is when the glands become overactive on their own - often after long-standing secondary disease or a kidney transplant.

  • How it is diagnosed

    A raised blood calcium alongside a high or non-suppressed PTH level. It is a simple biochemical pattern.

  • Where the gland is

    A Sestamibi nuclear scan and a high-resolution neck ultrasound pinpoint the faulty gland before surgery.

  • Definitive treatment

    Minimally-invasive parathyroidectomy (keyhole removal of the faulty gland) cures the great majority of primary cases.

Why this guide matters

A blood test, a scan, and a curable operation.

Hyperparathyroidism is common and quietly damaging. But it is usually curable, because a single small gland is doing the harm.

  • The diagnosis is biochemical

    Calcium and PTH show the pattern. Imaging comes next.

  • Localisation changes the operation

    Sestamibi and ultrasound turn a big neck exploration into a small, focused one.

  • Surgery is usually curative

    In primary disease, minimally-invasive parathyroidectomy cures the great majority of people.

How the diagnosis is made

From first blood test to a treatment plan.

The steps a UK GP, endocrinologist and endocrine surgeon usually follow, in order. So you know what to expect and why.

  1. 01

    Recognising

    Serum calcium (corrected)

    A corrected (albumin-adjusted) calcium confirms true hypercalcaemia (high blood calcium). This is the starting point of the whole work-up.

  2. 02

    Recognising

    Parathyroid hormone level

    A high or non-suppressed PTH alongside raised calcium confirms primary hyperparathyroidism.

  3. 03

    Confirming

    24-hour urinary calcium

    This rules out familial hypocalciuric hypercalcaemia (FHH). FHH is a harmless genetic look-alike and does not need surgery.

  4. 04

    Confirming

    Vitamin D level

    Low vitamin D is common and needs correcting. It helps your team read the PTH result and lowers the risk of low calcium after surgery.

  5. 05

    Confirming

    Bone-density DEXA

    A baseline scan of bone-mineral density at hip, spine and wrist (distal radius). Low density is one of the reasons to offer surgery.

  6. 06

    Managing

    Sestamibi scan + neck ultrasound

    These scans together find a single overactive gland. That means a small, focused operation instead of a big one.

  7. 07

    Managing

    Endocrinology and endocrine surgery

    A joint consultation to decide between watchful waiting, medicines or parathyroidectomy.

Typical timeline: 6-12 weeks from first raised calcium to a settled treatment plan.

Symptoms

What hyperparathyroidism actually feels like.

Many people are diagnosed after a routine blood test. When symptoms do appear, they cluster around bones, stones, tummy moans and low mood.

  • Asymptomatic

    Often picked up by chance on a routine blood test. Calcium is raised before any symptoms appear.

  • Bone pain and fractures

    Long-standing high PTH weakens bone. Fragility fractures and bone pain are classic signs.

  • Kidney stones

    Extra calcium in the urine forms calcium-oxalate and calcium-phosphate stones. Repeated renal colic is a red flag.

  • Abdominal moans

    Nausea, constipation, indigestion and vague tummy pain. High calcium slows the gut.

  • Renal impairment

    Long-term high calcium and stones can quietly damage the kidneys over years.

  • Low mood, fatigue

    Depression, poor concentration and tiredness. Often dismissed, but a known feature.

  • Osteoporosis

    Cortical bone loss shows first at the wrist (distal radius) on DEXA. It is a strong reason to consider surgery.

  • Red flag: hypercalcaemic crisis

    Dehydration, confusion or reduced consciousness with very high calcium. Call 999.

Treatment

How hyperparathyroidism is treated in the UK.

A curable operation for most primary cases. Medical and metabolic options are available for those who cannot have surgery, or who have secondary or tertiary disease.

  • Watchful waiting

    A reasonable option for mild disease with no symptoms that does not meet surgical criteria. Your team keeps a regular check on calcium, PTH, kidneys and DEXA.

  • Minimally-invasive parathyroidectomy

    The gold-standard operation for primary disease once Sestamibi has found the faulty gland. It uses a small, focused incision, a short hospital stay and gives high cure rates.

  • Bilateral neck exploration

    Used when scans disagree or more than one gland may be involved. The surgeon inspects all four glands and removes any abnormal tissue.

  • Cinacalcet

    A calcimimetic drug that lowers calcium and PTH. It is used when surgery is not possible, or for secondary hyperparathyroidism in dialysis patients.

  • Vitamin D and calcium optimisation

    Correcting a vitamin D deficiency eases the pressure on the parathyroid glands. It also prepares you for safer surgery.

  • Bisphosphonates for bone loss

    If osteoporosis continues, or surgery is delayed, these bone-protecting medicines help preserve bone-mineral density.

  • Renal transplantation

    For tertiary hyperparathyroidism after end-stage kidney disease, a successful transplant often calms the overactive glands over time.

  • Post-operative calcium monitoring

    A close watch for hungry-bone syndrome and short-term low calcium after parathyroidectomy. Calcium and vitamin D are given as needed.

What this guide is based on

The sources behind every number on this page.

UK national guidance and specialist society standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your GP, endocrinologist or endocrine surgeon knows your history. They can tell you which parts apply to you. If in doubt, ask for a calcium and PTH check.

  • NICE. Hyperparathyroidism (primary): diagnosis, assessment and initial management (NG132).

  • Society for Endocrinology - clinical guidance on parathyroid disorders.

  • British Association of Endocrine and Thyroid Surgeons (BAETS) - parathyroid surgery standards.

  • European Society of Endocrinology - guidance on primary and renal hyperparathyroidism.

Red flags

When hyperparathyroidism needs urgent attention.

Most hyperparathyroidism is worked up in clinic. These are the situations where it stops being routine, and you should act promptly.

  • Hypercalcaemic crisis

    Dehydration, reduced consciousness and very high calcium. This is a medical emergency - call 999.

  • Renal failure

    New or worsening kidney function alongside high calcium. This needs urgent assessment.

  • Nephrolithiasis with obstruction

    Stones causing a blockage or infection. This needs an urgent urology referral.

  • Fragility fracture

    A low-energy fracture together with raised calcium and PTH. It needs an urgent endocrine and bone-health review.

  • Post-op hypocalcaemia

    Tingling, cramps or muscle spasm (tetany) after parathyroidectomy. Have your calcium checked urgently and treated.

  • Persistent or recurrent hyperparathyroidism

    Calcium and PTH stay raised - or rise again - after surgery. This needs re-imaging in a specialist centre.

  • MEN syndrome family cascade

    A family history of pituitary, pancreatic or medullary thyroid tumours. This is a trigger for genetic testing and family screening.

  • Parathyroid carcinoma

    Very rare. It is suggested by a lump in the neck with very high calcium and PTH, and needs specialist surgery.

  • Pregnancy hypercalcaemia

    Raised calcium in pregnancy carries risk for mother and baby. This needs specialist obstetric endocrinology.

Living with it

A treatable condition, watched carefully.

Four small things that make the biggest difference. Keep your bloods on schedule, protect your bones, stay hydrated and attend your post-op reviews.

A quiet reminder

Tingling or cramps after parathyroidectomy? Call.

Low calcium is common in the first days after parathyroidectomy. A same-day calcium check settles it.

  1. 01 Bloods

    Keep every calcium check

    Regular calcium, PTH, kidney and vitamin D blood tests let your team spot changes early - before symptoms return.

  2. 02 Bones

    Protect your bone-mineral density

    Weight-bearing exercise, vitamin D and regular DEXA scans. Any surgery or medicine then works on a solid foundation.

  3. 03 Fluids

    Stay well hydrated

    Drinking enough fluid lowers your stone risk. It also softens the day-to-day impact of a raised calcium level.

  4. 04 Follow-up

    Attend post-op reviews

    Even after a successful operation, calcium is checked to spot hungry-bone syndrome and confirm you are cured.

Frequently asked

Everything we get asked about hyperparathyroidism.

Quick answers on calcium and PTH, Sestamibi scans, keyhole parathyroidectomy and hypercalcaemic crisis.

  • How is hyperparathyroidism diagnosed?

    By blood tests. A raised blood calcium with a high or non-suppressed PTH confirms primary hyperparathyroidism. A 24-hour urinary calcium test is added to rule out familial hypocalciuric hypercalcaemia (a harmless genetic look-alike).

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

    Primary is when the parathyroid glands become overactive on their own - usually from a single adenoma. Secondary is a natural response to low calcium, most often from chronic kidney disease or low vitamin D. Tertiary is when secondary disease turns autonomous, often after long-standing kidney failure or a transplant.

  • Do I need surgery?

    Not always. Surgery is offered if you have symptoms, a significantly raised calcium, reduced kidney function, kidney stones, osteoporosis, or if you are younger. Mild disease without symptoms can be watched with regular monitoring.

  • What is a Sestamibi scan?

    A nuclear medicine scan that lights up overactive parathyroid tissue. It is usually combined with a neck ultrasound. Together they pinpoint a single adenoma and allow a small, focused (keyhole) operation.

  • What is minimally-invasive parathyroidectomy?

    A focused operation on the faulty gland through a small neck incision. It is usually done under general anaesthetic with a short hospital stay. In experienced hands, cure rates are very high.

  • What is hypercalcaemic crisis?

    A dangerously high calcium level that causes dehydration, confusion or reduced consciousness. It is a medical emergency. Call 999 - you will need intravenous fluids and calcium-lowering treatment in hospital.

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