Hyperparathyroidism in Singapore: Understanding the Condition

Hyperparathyroidism is a condition in which one or more parathyroid glands become overactive and produce more parathyroid hormone (PTH) than the body requires. These small glands play an important role in regulating calcium levels in the bloodstream. When excess hormone is released, this balance is disrupted. Potentially affecting the bones, kidneys and other organs. Although hyperparathyroidism can be complex, understanding its effects on the body is an important step in managing the condition.

What Are the Signs and Symptoms of Hyperparathyroidism?

Hyperparathyroidism is often called a ‘silent’ condition because many people do not experience obvious symptoms in the early stages. Instead, it is frequently discovered by accident during routine blood tests that show elevated calcium levels.

When symptoms do appear, they can often be vague or subtle. Leading many to dismiss them as general fatigue or discomfort affecting different parts of the body.

Common signs and symptoms include:

• Persistent tiredness (lethargy) or muscle weakness.
• Bone and joint pain, commonly affecting the legs, arms or back.
• Increased thirst or frequent urination.
• Kidney stone formation due to excess calcium in urine.
• Nausea, vomiting, abdominal discomfort or constipation.
• Difficulty concentrating, memory loss or low mood.

For those with secondary and tertiary hyperparathyroidism, symptoms are often related to the underlying kidney failure or bone disease. These include severe bone deformities, increased risk of fractures due to renal osteodystrophy (bone disease related to kidney failure) and calcification in blood vessels or soft tissues.

What Are the Different Types of Hyperparathyroidism?

Hyperparathyroidism is generally classified into three types, based on the underlying cause of the hormone overproduction. These include: 

Primary Hyperparathyroidism

Primary hyperparathyroidism occurs when one or more parathyroid glands become overactive due to a benign parathyroid adenoma or gland enlargement. This results in elevated blood calcium levels, which can lead to various health problems if left untreated.

Secondary Hyperparathyroidism

This type of hyperparathyroidism is more common in individuals with long-term renal conditions and those with severe vitamin D deficiency, where the parathyroid glands are overworking to compensate for low calcium levels in the body.

Tertiary Hyperparathyroidism

This can develop in individuals with long-standing secondary hyperparathyroidism, often due to chronic kidney disease. The parathyroid glands may become permanently overactive even after the underlying cause of low calcium is corrected. At this stage, the glands act autonomously and no longer respond to the body’s signals.

How Is Hyperparathyroidism Diagnosed?

Diagnosis typically begins with blood tests to measure levels of calcium and parathyroid hormone. If these tests indicate hyperparathyroidism, further tests or imaging scans may be ordered to help assess the impact of the condition or locate the overactive glands, including:

• Bone mineral density testing: Because excess PTH leaches calcium from the bones, a dual-energy X-ray absorptiometry (DEXA) scan is used to check for osteoporosis or bone loss caused by excess PTH.
• Urine tests: A 24-hour urine collection test measures how much calcium is being removed from the body by the kidneys. This helps distinguish hyperparathyroidism from other conditions.
• Sestamibi Parathyroid Scan: A safe radioactive tracer is injected into the body, which is absorbed by the overactive gland, allowing it to light up on the scan to identify its specific location.
• Ultrasound: This test uses high-frequency sound waves to create images of the thyroid and parathyroid area.
• CT Scan (4D-CT): This specialised CT scan provides detailed cross-sectional images to precisely locate the adenoma, which is especially helpful before surgery.

How Is Hyperparathyroidism Managed and Treated?

Treatment for hyperparathyroidism depends on the type and severity of the condition. Doctors will assess your calcium levels, kidney function and bone density to recommend the most appropriate path. Some common treatment options include:

Non-Surgical Management

If you have mild hyperparathyroidism and no symptoms, your doctor may recommend a ‘watch and wait’ approach. This involves regular monitoring of your calcium levels, kidney function and bone density to ensure the condition does not worsen. Medications like calcimimetics (which mimic calcium in the blood) or bisphosphonates (to protect bones) may be prescribed to manage symptoms.

Surgical Treatment

Surgery is the only definitive treatment for primary hyperparathyroidism. Parathyroidectomy, which is the removal of the overactive gland(s), is recommended when:

• Calcium levels are significantly high
• Kidney stones or bone disease (osteoporosis) are present
• The patient is under 50 years old
• Symptoms are affecting quality of life

Advancements in medical technology allow for minimally invasive parathyroidectomy in Singapore. If the preoperative scan locates the single overactive adenoma, the surgeon can perform the procedure through a small incision. Resulting in less pain, minimal scarring and a faster recovery.

Is Hyperparathyroidism Cancerous?

Some studies suggest that individuals with hyperparathyroidism may have a slightly higher chance of getting other types of cancer, like breast, colon or skin cancer. But this does not mean that hyperparathyroidism itself is cancer. Most people with the condition can be treated successfully with or without surgery and maintain a good quality of life.

If cancer is suspected based on clinical, laboratory or imaging findings, referral to an oncologist with expertise in parathyroid conditions is advised. This ensures accurate assessment and timely treatment.

Living With Hyperparathyroidism

Living with hyperparathyroidism can be challenging, especially when its symptoms affect your daily life. However, it is still a highly treatable condition. Whether through careful monitoring or parathyroid surgery, appropriate management is key to preventing long-term damage to your bones and kidneys.

At Dennis Lim Surgery, patients receive personalised care guided by careful diagnosis and evidence-based treatment planning. Dr Dennis Lim works closely with each individual to understand their condition, address concerns and recommend the most appropriate management approach. For guidance on hyperparathyroidism and available treatment options, contact us today to schedule an appointment with our specialist.

Our Oncology Surgeon

Dr Dennis T H Lim
Head and Neck General Surgeon
MBBS (Singapore), M.Med (Surgery), FRCS (Edinburgh), FRCS (Glasgow), FAMS (Surgery)

Dr Dennis Lim is a specialist in head and neck surgical oncology, with particular expertise in tumour surgery. Trained at the Memorial Sloan-Kettering Cancer Center, New York, Dr Lim previously served as senior consultant surgical oncologist at the National Cancer Centre and Singapore General Hospital. He now runs a private practice, offering personalised, multidisciplinary care and employing advanced surgical techniques to achieve optimal outcomes for patients with head, neck and skin tumours.