Health condition · Clinically reviewed
Hyperparathyroidism, primary, secondary and tertiary — modern diagnosis and surgery.
Overactive parathyroid glands with excess PTH. Primary hyperparathyroidism is usually curable by minimally-invasive parathyroidectomy after Sestamibi localisation.
Why trust this guide
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Clinically reviewed
Written by our editorial team and reviewed by a registered UK clinician before publication.
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Sourced from guidance
Every claim is checked against NICE, BAETS or peer-reviewed sources you can see at the end.
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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.
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What it is
Elevated parathyroid hormone (PTH) with hypercalcaemia in primary disease — overactive parathyroid glands driving calcium out of bone into blood.
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Most common cause
A single benign parathyroid adenoma — accounts for around 85% of primary hyperparathyroidism.
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Secondary and tertiary
Secondary reflects chronic renal failure or vitamin D deficiency; tertiary is autonomous gland behaviour, often after long-standing secondary disease or post-transplant.
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How it is diagnosed
Raised serum calcium with an inappropriately high or non-suppressed PTH level — a simple biochemical pattern.
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Where the gland is
Sestamibi nuclear scan and high-resolution neck ultrasound localise the abnormal gland before surgery.
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Definitive treatment
Minimally-invasive parathyroidectomy is curative in the great majority of primary cases.
Why this guide matters
A blood test, a scan, and a curable operation.
Hyperparathyroidism is common, quietly damaging, and usually curable — because a single small gland is doing the harm.
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The diagnosis is biochemical
Calcium and PTH tell you the pattern; imaging comes next.
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Localisation changes the operation
Sestamibi and ultrasound turn a big neck exploration into a small focused one.
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Surgery is usually curative
In primary disease, minimally-invasive parathyroidectomy cures the great majority.
How the diagnosis is made
From first blood test to a treatment plan.
The steps a UK GP, endocrinologist and endocrine surgeon will normally follow, in order — so you know what to expect and why.
Phase 1 · Recognising
Calcium and PTH pattern
Phase 2 · Confirming
Rule out FHH, check vitamin D and bone density
Phase 3 · Managing
Localisation and endocrine-surgery review
- 01
Recognising
Serum calcium (corrected)
A corrected (albumin-adjusted) calcium confirms true hypercalcaemia — the starting point for the whole workup.
- 02
Recognising
Parathyroid hormone level
An inappropriately high or non-suppressed PTH with a raised calcium confirms primary hyperparathyroidism.
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Confirming
24-hour urinary calcium
Rules out familial hypocalciuric hypercalcaemia (FHH) — a benign genetic mimic that does not need surgery.
- 04
Confirming
Vitamin D level
Deficiency is common and needs correcting to interpret PTH accurately and reduce post-op hungry-bone risk.
- 05
Confirming
Bone-density DEXA
Baseline bone-mineral density at hip, spine and distal radius — one of the criteria for offering surgery.
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Managing
Sestamibi scan + neck ultrasound
Nuclear localisation combined with ultrasound identifies a single adenoma and enables a minimally-invasive operation.
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Managing
Endocrinology and endocrine surgery
Joint consultation to decide between watchful waiting, medical therapy 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, abdominal moans and psychiatric groans.
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Asymptomatic
Often picked up incidentally on a routine blood test — a raised calcium found before any symptoms.
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Bone pain and fractures
Long-standing PTH excess weakens bone — fragility fractures and bone pain are classic features.
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Kidney stones
Hypercalciuria drives calcium-oxalate and calcium-phosphate stones — recurrent renal colic is a red flag.
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Abdominal moans
Nausea, constipation, indigestion and non-specific abdominal pain — the gut slows with hypercalcaemia.
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Renal impairment
Chronic hypercalcaemia and stones can quietly reduce kidney function over years.
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Low mood, fatigue
Depression, poor concentration and tiredness — often dismissed but a recognised feature.
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Osteoporosis
Cortical bone loss shows first at the distal radius on DEXA — a strong indication for surgery.
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Red flag: hypercalcaemic crisis
Dehydration, confusion or altered consciousness with very high calcium — call 999.
Treatment
How hyperparathyroidism is treated in the UK.
A curable operation for most primary cases, with medical and metabolic options for those who cannot have surgery or who have secondary or tertiary disease.
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Watchful waiting
Reasonable for mild, asymptomatic disease that does not meet surgical criteria — with regular calcium, PTH, kidney and DEXA monitoring.
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Minimally-invasive parathyroidectomy
The gold standard for primary disease after Sestamibi localisation — a small focused incision, short hospital stay and high cure rates.
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Bilateral neck exploration
Used when imaging is discordant or multi-gland disease is suspected — all four glands are inspected and abnormal tissue removed.
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Cinacalcet
A calcimimetic that lowers calcium and PTH — reserved for unresectable primary disease and for secondary hyperparathyroidism in dialysis patients.
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Vitamin D and calcium optimisation
Correcting deficiency reduces secondary drive on the parathyroid glands and prepares patients for safer surgery.
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Bisphosphonates for bone loss
Where osteoporosis persists or surgery is deferred, antiresorptive therapy protects bone mineral density.
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Renal transplantation
In tertiary hyperparathyroidism after end-stage renal disease, a successful transplant often reverses the autonomous drive over time.
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Post-operative calcium monitoring
Close observation for hungry-bone syndrome and transient hypocalcaemia after parathyroidectomy — with calcium and vitamin D 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 and can tell you which parts apply to you. If in doubt, ask for a calcium and PTH check.
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NICE. Hyperparathyroidism (primary): diagnosis, assessment and initial management (NG132).
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Society for Endocrinology — clinical guidance on parathyroid disorders.
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British Association of Endocrine and Thyroid Surgeons (BAETS) — parathyroid surgery standards.
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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.
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Hypercalcaemic crisis
Dehydration, altered consciousness and very high calcium — a medical emergency; call 999.
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Renal failure
New or worsening kidney function alongside hypercalcaemia needs urgent assessment.
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Nephrolithiasis with obstruction
Stones causing obstruction or infection — urgent urology referral.
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Fragility fracture
A low-energy fracture in the context of raised calcium and PTH — urgent endocrine and bone-health review.
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Post-op hypocalcaemia
Tingling, cramps or tetany after parathyroidectomy — check calcium urgently and treat.
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Persistent or recurrent hyperparathyroidism
Calcium and PTH remaining raised (or rising again) after surgery — needs re-imaging in a specialist centre.
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MEN syndrome family cascade
Family history of pituitary, pancreatic or medullary thyroid tumours — trigger for genetic testing and family screening.
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Parathyroid carcinoma
Very rare — suggested by a palpable neck mass with a very high calcium and PTH; needs specialist surgery.
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Pregnancy hypercalcaemia
Raised calcium in pregnancy carries maternal and fetal risk — specialist obstetric endocrinology.
Living with it
A treatable condition, watched carefully.
Four small things that make the biggest difference — keeping bloods on schedule, protecting bone, staying hydrated and attending post-op reviews.
A quiet reminder
Tingling or cramps after parathyroidectomy? Call.
Post-op hypocalcaemia is common in the first days after surgery — a same-day calcium check settles it.
- 01 Bloods
Keep every calcium check
Regular calcium, PTH, kidney and vitamin D bloods let your team catch drift early — before symptoms return.
- 02 Bones
Protect your bone mineral density
Weight-bearing exercise, vitamin D and DEXA monitoring — surgery or medication then works on a solid foundation.
- 03 Fluids
Stay well hydrated
Good fluid intake lowers stone risk and reduces the impact of a raised calcium level day to day.
- 04 Follow-up
Attend post-op reviews
Even after a successful operation, calcium is checked to detect hungry-bone syndrome and confirm cure.
Frequently asked
Everything we get asked about hyperparathyroidism.
Quick answers on calcium and PTH, Sestamibi localisation, minimally-invasive parathyroidectomy and hypercalcaemic crisis.
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How is hyperparathyroidism diagnosed?
By blood tests — a raised serum calcium with an inappropriately high or non-suppressed PTH confirms primary hyperparathyroidism. A 24-hour urinary calcium is added to exclude familial hypocalciuric hypercalcaemia.
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What is the difference between primary, secondary and tertiary?
Primary is autonomous overactivity of the parathyroid glands, usually from a single adenoma. Secondary is a physiological response to low calcium — most often from chronic kidney disease or vitamin D deficiency. Tertiary is when secondary disease becomes autonomous, often after long-standing renal failure or transplantation.
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Do I need surgery?
Not always. Surgery is offered for symptomatic disease, significantly raised calcium, reduced kidney function, kidney stones, osteoporosis, or younger age. Mild asymptomatic disease can be watched with regular monitoring.
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What is a Sestamibi scan?
A nuclear medicine scan that highlights overactive parathyroid tissue, usually combined with a neck ultrasound. Together they localise a single adenoma and allow a minimally-invasive operation through a small incision.
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What is minimally-invasive parathyroidectomy?
A focused operation on the localised abnormal gland through a small neck incision, typically under general anaesthetic with a short hospital stay. Cure rates in experienced hands are very high.
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What is hypercalcaemic crisis?
A dangerously high calcium level causing dehydration, confusion or altered consciousness. It is a medical emergency — call 999 and expect intravenous fluids and calcium-lowering treatment in hospital.
Related content
Keep reading.
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Blood tests
Calcium, PTH and vitamin D — the biochemistry behind diagnosis.
Learn more -
Thyroid function panel
TSH, free T4 and free T3 — often checked alongside parathyroid work-up.
Learn more -
DEXA scan
Bone-mineral density measurement — a key surgical criterion.
Learn more -
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