Quick answer. Hyperparathyroidism is when one or more parathyroid glands become overactive and push blood calcium too high, which can cause tiredness, bone pain, kidney stones and low mood. It is often picked up on a routine blood test, and surgery to remove the overactive gland can cure it.
Hyperparathyroidism happens when the parathyroid glands – four tiny glands in the neck behind the thyroid – make too much parathyroid hormone, raising the level of calcium in the blood. In Singapore it is increasingly found by chance when a routine blood test shows a raised calcium, often before any obvious symptoms appear.
The classic description of its effects is remembered as bones, stones, groans and moans – bone aches, kidney stones, tummy upset and low mood or tiredness. This guide explains what hyperparathyroidism is, the symptoms it can cause, how endocrinologists diagnose it, and the treatment options, including the surgery that can cure the common form.
At a glance
| Type | What is happening | Typical setting |
|---|---|---|
| Primary | A parathyroid gland is overactive on its own | High calcium found on blood tests |
| Secondary | Glands overwork in response to low calcium or vitamin D | Often kidney disease or vitamin D deficiency |
| Tertiary | Glands stay overactive after long secondary disease | Usually advanced or long-standing kidney disease |
| Asymptomatic | Raised calcium but no clear symptoms | Picked up incidentally; monitored or treated |
| Symptomatic | Bone, kidney, gut or mood symptoms present | May favour surgery |
What is hyperparathyroidism?
The parathyroid glands control the level of calcium in your blood using parathyroid hormone (PTH). When a gland becomes overactive, it releases too much PTH, which pulls calcium out of the bones and raises blood calcium. The most common form, primary hyperparathyroidism, is usually due to a single benign growth (an adenoma) on one gland.
It is more common with increasing age and in women, though it can affect anyone. Many people have no symptoms and are diagnosed only because a blood test shows a high calcium. Left unchecked over years, high calcium can weaken bones and contribute to kidney stones, so it is worth assessing properly.
Symptoms & signs
Many people feel well, and the condition is found on a blood test. When symptoms do occur, they reflect the raised calcium and may include:
- Tiredness, low energy and weakness
- Low mood, irritability or difficulty concentrating
- Bone and joint aches; over time, thinning bones (osteoporosis)
- Kidney stones, causing pain or blood in the urine
- Passing more urine and feeling thirsty
- Constipation, nausea, poor appetite or tummy discomfort
The old saying bones, stones, groans and moans captures this mix of bone, kidney, abdominal and mood symptoms.
Causes & risk factors
The cause depends on the type:
- Primary – most often a single benign parathyroid adenoma; less commonly enlargement of several glands
- Secondary – the glands overwork to compensate for low calcium, usually from chronic kidney disease or vitamin D deficiency
- Tertiary – long-standing secondary disease where the glands keep over-producing PTH on their own
Risk factors and associations include older age, being female, previous radiation to the neck, long-standing kidney disease, low vitamin D, and rare inherited conditions affecting the glands.
How it's diagnosed
Diagnosis is mainly through blood tests, confirmed with imaging when surgery is considered:
- Blood tests showing raised calcium together with a raised or inappropriately normal PTH level
- Vitamin D, kidney function and phosphate levels to build the full picture
- 24-hour urine calcium in some cases to help distinguish the cause
- A bone density (DEXA) scan to check for bone thinning
- Imaging to localise the overactive gland before surgery, such as an ultrasound of the neck and a sestamibi (nuclear) scan
Treatment options
Treatment depends on the type, the calcium level and whether there are symptoms or complications:
- Surgery (parathyroidectomy) – removing the overactive gland is the main cure for primary hyperparathyroidism, especially with symptoms, high calcium, kidney stones, reduced kidney function or significant bone loss
- Monitoring – if calcium is only mildly raised and you have no symptoms, your doctor may follow your calcium, kidney function and bone density over time
- Treating the underlying cause – for secondary disease, correcting vitamin D deficiency and managing kidney disease
- Medicines in selected cases to lower calcium or PTH when surgery is not suitable
- General measures such as staying well hydrated and reviewing supplements with your doctor
An endocrinologist, often working with a surgeon, will recommend the right path for you.
When to see a doctor & which specialist
See a doctor if a blood test has shown a high calcium, or if you have unexplained bone aches, recurrent kidney stones, persistent tiredness or low mood that has no clear cause. These can be worth checking for an overactive parathyroid.
Very high calcium can occasionally cause severe symptoms – marked confusion or drowsiness, severe vomiting, severe weakness or dehydration. If someone becomes very drowsy, confused or unwell with these features, seek urgent medical care and call 995 if they are seriously unwell.
Hyperparathyroidism is managed by an endocrinologist, often alongside a surgeon. You can find a specialist through our directory of endocrinologists in Singapore.
What to expect at the appointment
Hyperparathyroidism is often picked up when a routine blood test shows a raised calcium. At your appointment, the doctor will repeat or review your calcium and parathyroid hormone levels, check your vitamin D and kidney function, and ask about symptoms such as tiredness, bone aches, kidney stones or low mood. If surgery is being considered, imaging of the neck helps locate the overactive gland beforehand.
Self-care while you are being assessed
- Drink plenty of fluids to help your kidneys handle the extra calcium and reduce stone risk.
- Stay active, as weight-bearing activity supports bone health.
- Do not start or stop calcium or vitamin D supplements without checking with your doctor, as both can affect your levels.
Questions to ask your doctor
- Is my hyperparathyroidism primary, or a response to another problem?
- Do I need surgery, or can my levels be monitored over time?
- What do my bone density and kidney results mean for me?
Costs and financing in Singapore
Blood tests, scans, bone density assessment and parathyroid surgery are available at public hospitals with subsidies for eligible patients. MediSave can usually be used towards hospitalisation and surgery within the set withdrawal limits. Ask your care team about the costs and schemes that apply to you.
Common questions
Can surgery really cure it?
For the common primary form caused by a single overactive gland, removing that gland cures the condition in most people and calcium usually returns to normal.
What if I have no symptoms?
If calcium is only mildly raised and you feel well, your doctor may monitor your calcium, kidney function and bone density over time rather than operate straight away.
Related guides
- Best Endocrinology & Diabetes Clinics in Singapore — our editorial shortlist
- endocrinology & diabetes clinics directory
- Myasthenia gravis
- Cushing's syndrome
- Ovarian cancer
- Endometrial cancer
- Bartholin's cyst
Sources
- NHS – Hyperparathyroidism
- Mayo Clinic – Hyperparathyroidism
- HealthHub Singapore
- SingHealth – Conditions and treatments
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