What the parathyroid glands are and why they matter
You have four parathyroid glands, each the size of a grain of rice, embedded in the back of your thyroid. They are separate organs with a different job: they control calcium levels in your blood by releasing parathyroid hormone (PTH). Calcium is essential for nerve signals, muscle contraction, and bone strength. When blood calcium drops, your parathyroids release PTH to bring it back up. When calcium is high enough, they stop.
This system usually works silently. But when a parathyroid gland grows too large or produces too much hormone, calcium builds up in your blood. When one or more glands stop working, calcium drops too low. Either way, you may feel symptoms—or you may feel nothing at all and only discover the problem during a blood test.
The distinction matters because parathyroid problems are treated differently from thyroid problems, require different specialists, and have different surgery options if surgery becomes necessary.
Key Takeaways
- Parathyroid glands control blood calcium through PTH, not thyroid hormone, so a parathyroid problem is separate from a thyroid problem even though they sit next to each other.
- High calcium (hyperparathyroidism) often causes no symptoms and is found by accident on a blood test, but can lead to kidney stones and bone loss over time.
- Low calcium (hypoparathyroidism) is rarer and usually happens after thyroid or neck surgery, causing tingling, muscle cramps, or seizures if severe.
- An endocrinologist or a surgeon specializing in parathyroid disease can order the right tests and discuss whether you need surgery or monitoring.
Hyperparathyroidism: Too much calcium in the blood
Hyperparathyroidism means one or more parathyroid glands produce too much PTH, pushing blood calcium above normal. The most common cause is a single benign growth (adenoma) on one gland. Less often, all four glands enlarge (hyperplasia), or rarely, cancer develops.
Many people have no symptoms at all. The condition is discovered when a doctor orders routine bloodwork for another reason and sees elevated calcium. Others experience kidney stones, bone pain, fatigue, brain fog, or mood changes. The phrase "stones, bones, groans, and psychiatric overtones" is how doctors remember the possible symptoms—though you may have none of them.
The decision to treat depends on your calcium level, whether your kidneys or bones are already affected, and your age. Some people with mild hyperparathyroidism are monitored with periodic blood tests and bone density scans rather than having surgery right away. Others need surgery to remove the affected gland or glands. A parathyroid surgeon uses imaging and sometimes a radioactive tracer to locate the problem gland during the operation.
Hypoparathyroidism: Too little calcium in the blood
Hypoparathyroidism means the parathyroid glands do not produce enough PTH, so blood calcium falls below normal. This is much rarer than hyperparathyroidism. The most common cause is damage to the glands during thyroid surgery, neck surgery, or radiation to the neck. Rarely, it is present from birth or develops as an autoimmune condition.
Symptoms appear when calcium drops significantly: tingling in the lips, fingers, and toes; muscle cramps or spasms; numbness; or in severe cases, seizures. Mild cases may cause only subtle symptoms like fatigue or difficulty concentrating. The condition is diagnosed by a blood test showing low calcium and low or inappropriately normal PTH.
Treatment involves taking calcium supplements and often calcitriol (an active form of vitamin D) by mouth. The goal is to raise blood calcium to a safe level while avoiding calcium that is too high. This requires periodic blood tests to adjust the dose. Unlike hyperparathyroidism, hypoparathyroidism cannot be cured by surgery—it is managed long-term with medication.
How parathyroid problems are diagnosed
Diagnosis starts with a blood test measuring calcium, phosphate, and PTH. If calcium is abnormal, your doctor will repeat the test to confirm it is not a temporary fluctuation. They may also check kidney function, vitamin D level, and sometimes order imaging such as ultrasound or a CT scan to look for a growth on a gland.
For hyperparathyroidism, if surgery is being considered, a specialized imaging test called a sestamibi scan or parathyroid scintigraphy helps the surgeon locate which gland is overactive. This test uses a small amount of radioactive tracer that concentrates in overactive parathyroid tissue.
For hypoparathyroidism, diagnosis is usually straightforward from the blood test pattern. Imaging is not typically needed unless the cause is unclear or there is a history of neck surgery or radiation.
When to see a specialist and what to expect
If your primary care doctor finds abnormal calcium or PTH, they may refer you to an endocrinologist (a doctor specializing in glands and hormones) or a parathyroid surgeon. An endocrinologist evaluates whether you need treatment and monitors you over time. A parathyroid surgeon performs the operation if surgery is the right choice and can also manage medical treatment.
At your first appointment, bring any recent blood test results and a list of symptoms you have noticed. The doctor will ask about your medical history, any neck surgery or radiation, current medications, and family history of parathyroid or calcium problems. They will explain your test results, discuss whether your condition needs treatment now or monitoring, and outline your options.
If surgery is recommended, the surgeon will explain the procedure, the risks (which include temporary or permanent low calcium if too much parathyroid tissue is removed), and what to expect during recovery. Most parathyroid surgery is outpatient or requires only one night in the hospital.
Living with parathyroid disease: Monitoring and follow-up
If you have hyperparathyroidism and are not having surgery, your doctor will order blood tests and sometimes bone density scans (DEXA scans) at regular intervals—usually every 6 to 12 months—to watch for worsening. You should report new symptoms like kidney stones, severe fatigue, or bone pain. Some people remain stable for years; others eventually choose surgery because symptoms develop or test results worsen.
If you have hypoparathyroidism, you will need regular blood tests to keep your calcium and medication dose in the right range. This is especially important if you become pregnant, change your diet significantly, or start new medications, because these can affect how your body handles calcium. Your doctor may adjust your supplement dose based on your blood test results.
In both cases, staying in touch with your doctor and reporting changes helps catch problems early and keeps your treatment on track.
Frequently Asked Questions
Is parathyroid disease the same as thyroid disease?
No. The parathyroid glands sit on the thyroid but are separate organs with different jobs. The thyroid makes thyroid hormone, which controls metabolism. The parathyroids make PTH, which controls calcium. You can have one condition without the other, though both can happen together.
Can parathyroid problems go away on their own?
Hyperparathyroidism caused by an adenoma does not go away without surgery. Hypoparathyroidism caused by surgery or radiation does not reverse. However, mild hyperparathyroidism may remain stable for years without worsening, so surgery is not always urgent.
What happens if high calcium is left untreated?
Over time, high calcium can damage the kidneys, weaken bones, and increase the risk of kidney stones. Some people have no problems for years; others develop complications. Your doctor will discuss your individual risk based on how high your calcium is and other factors.
Can I take calcium supplements if I have hyperparathyroidism?
Usually no. Extra calcium can make hyperparathyroidism worse. Your doctor will advise you on what to avoid. If you have hypoparathyroidism, calcium supplements are essential and prescribed as part of your treatment.
Will parathyroid surgery affect my thyroid?
A parathyroid surgeon works on the parathyroid glands specifically and takes care to avoid damaging the thyroid. Thyroid problems after parathyroid surgery are uncommon, but your doctor will monitor your thyroid function if needed.