Hyperparathyroidism: High Calcium, Bone Loss, and When Surgery Is Needed

When your blood calcium stays too high for too long, your body starts eating itself. Not metaphorically-literally. Your bones weaken. Your kidneys form stones. You feel tired all the time, even after sleeping. And your brain? It feels foggy, like you're stuck in slow motion. This isn't just aging. It's hyperparathyroidism.

What Exactly Is Hyperparathyroidism?

Your parathyroid glands are four tiny pea-sized organs tucked behind your thyroid in the neck. They don’t make thyroid hormone. They make PTH-parathyroid hormone. And their only job is to keep your blood calcium in a narrow, safe range: between 8.5 and 10.2 mg/dL.

When calcium drops too low, PTH kicks in. It tells your bones to release calcium, your gut to absorb more from food, and your kidneys to hold onto calcium instead of peeing it out. Simple. Smart. Until it goes wrong.

In primary hyperparathyroidism, one or more of these glands start pumping out too much PTH-on their own. No reason. No trigger. Just broken. And because of that, your calcium skyrockets. Often above 10.5 mg/dL. Sometimes over 12 mg/dL. That’s not just high. That’s dangerous.

This isn’t rare. About 100,000 Americans get diagnosed each year. Women are three times more likely than men. And in African-American communities, rates are even higher. Most people are over 50 when it shows up. But it can hit younger people too.

How It Breaks Your Bones

Your bones aren’t just scaffolding. They’re storage units for calcium. When PTH is stuck on high, your bones become a cash machine. Osteoclasts-cells that break down bone-go into overdrive. Calcium pours into your blood. And your bones? They get hollow.

A DXA scan (the same test used for osteoporosis) shows this clearly. People with untreated hyperparathyroidism lose 2% to 4% of bone density every year in their spine and hips. That’s faster than most postmenopausal women lose bone. And it doesn’t stop until the PTH is turned off.

The result? A 30% to 50% higher chance of breaking a bone. A hip fracture at 65 can change your life forever. A wrist fracture from a simple fall? That’s often the first sign something’s wrong.

More Than Just Bones: The Hidden Symptoms

You might not feel like you have a disease. Many people don’t. That’s why it’s often missed for years.

But if you’ve had:

• Chronic fatigue that no amount of sleep fixes
• Brain fog-forgetting names, losing focus at work
• Recurrent kidney stones
• Bone or joint pain that won’t go away
• Depression or anxiety that doesn’t respond to therapy

…you might have hyperparathyroidism. Not because you’re stressed. Not because you’re getting older. Because your calcium is too high.

A survey of over 1,200 patients on EndocrineWeb found that 78% listed bone pain and fatigue as their worst symptoms. Sixty-five percent said their brain fog affected their job performance. One woman wrote: “After seven years of being told I was depressed, my calcium was 11.8 and my PTH was 142. After surgery, it was like someone flipped a switch. My brain came back.”

How Doctors Diagnose It

It starts with a simple blood test. Two things matter: calcium and PTH.

If your calcium is above 10.5 mg/dL and your PTH is above 65 pg/mL, that’s a clear sign. But here’s the twist: 20% of people have PTH levels that look “normal” on paper-between 15 and 65. But if your calcium is high and your PTH isn’t suppressed, that’s still abnormal. It’s like your car’s gas light is on, but the mechanic says the fuel tank is fine. It’s not.

Doctors will usually check calcium twice, a week apart, to rule out a lab error or temporary spike. If both are high, they’ll order imaging.

The go-to test is a sestamibi scan-a nuclear medicine test that lights up the overactive gland. It’s 90% accurate for finding a single adenoma (the most common cause). Ultrasound is used too. For complex cases, a 4D-CT scan can pinpoint the problem with 95% accuracy.

When Surgery Is the Only Cure

There’s no pill that fixes this. Medications like cinacalcet can lower PTH a bit, but they don’t cure it. They’re for people who can’t have surgery-like those with severe kidney disease.

For everyone else, surgery is the only way to get back to normal.

The procedure is called a parathyroidectomy. It’s minimally invasive. Most patients go home the same day. The surgeon makes a small cut in the neck, finds the bad gland, and removes it. If there’s more than one bad gland, they remove most of them but leave a little bit to keep calcium stable.

Success rates? 95% to 98% for single-gland disease. 85% to 90% for multigland. And here’s the best part: bone density starts to improve within a year. Most people gain 3% to 5% in their spine after 12 months. After two years? Up to 8%.

The American Association of Endocrine Surgeons says surgery should be offered if:

• Your calcium is more than 1 mg/dL above the upper limit of normal
• Your kidney function is below 60 mL/min
• Your bone density T-score is -2.5 or lower (osteoporosis)
• You’re under 50 years old

Even if you feel fine, if you meet one of these, surgery is recommended. The longer you wait, the harder it is to reverse the damage.

What Happens After Surgery?

You might feel better fast. Some people say their brain fog lifts in days. Fatigue fades. Kidney stones stop forming.

But there’s a catch: your body is suddenly without its old calcium pump. Your bones start sucking calcium back in. And your blood calcium can crash.

About 30% to 40% of patients get temporary low calcium after surgery. That means tingling in the fingers, muscle cramps, or even seizures in rare cases. It’s treated with calcium and vitamin D supplements-usually for 2 to 8 weeks. Most people stop needing them after a few months.

If you had multigland disease, you’ll need annual blood tests for life. There’s a 5% to 10% chance the problem comes back. Single-gland removal? Only 2% to 3% recurrence.

Why Some People Delay Surgery

Many patients are told to “wait and watch.” But waiting isn’t harmless.

A Mayo Clinic study of 1,200 patients found that those with calcium above 12 mg/dL for years had a 22% chance of still feeling tired or foggy after surgery. Those with calcium below 11 mg/dL? Only 8% had lingering symptoms.

The longer you wait, the more likely some damage becomes permanent.

Another reason people delay? Fear. They worry about voice changes. But the risk of permanent nerve damage from an experienced surgeon is less than 1%. And in high-volume centers (surgeons who do over 50 of these a year), the success rate jumps to 98%.

What You Can Do Now

If you’ve been told your calcium is high and your doctor says “it’s not a big deal,” ask for a second opinion. Ask for PTH levels. Ask about imaging. Ask about surgery.

In the meantime:

• Drink plenty of water-helps flush excess calcium
• Get 1,200 mg of calcium daily from food, not supplements
• Do weight-bearing exercise-walking, lifting, dancing-30 minutes a day
• Avoid thiazide diuretics (like hydrochlorothiazide) if you can-they make calcium go up
• Check your vitamin D. If it’s low, get it corrected before surgery

The Future Is Brighter

New tools are making diagnosis faster and surgery safer. AI is now helping radiologists spot abnormal glands on scans with 98% accuracy. A new drug called etelcalcetide showed 45% PTH reduction in trials-though it’s still being studied for primary hyperparathyroidism.

But the truth hasn’t changed: if you have this condition, and you’re a candidate for surgery, doing nothing is the riskiest choice.

Your bones, your kidneys, your brain-they’re all counting on you to act before it’s too late.