Secondary Hyperparathyroidism: Parathyroid glands, Symptoms, Causes and Treatment

It occurs when the parathyroid glands enlarge and release too much PTH, causing a high level of PTH in the blood.

There are several reasons why this happens in patients with kidney disease:

  • High levels of phosphorus in the blood.
  • The kidneys can not make vitamin D active (needed to absorb calcium).
  • Lower levels of calcium in the blood.

Secondary hyperparathyroidism can cause bone disease. It can also cause the accumulation of calcium in tissues and organs such as the heart and blood vessels.

What are the parathyroid glands?

The parathyroid glands are four tiny glands found near the thyroid gland in the neck.

Each one is the size of a pea. The parathyroid glands produce and release parathyroid hormones (hormones are secretions made by your body to help your bodywork and keep it healthy).

What is parathyroid hormone (PTH)?

Parathyroid hormone (also called PTH) controls the amount of calcium in the blood and inside the bones.

The release of PTH is activated and deactivated depending on the calcium levels in your blood. For example, if the level of calcium in the blood decreases, the parathyroid glands will release more PTH; this will cause the bones to release calcium and increase the level of calcium in the blood.



Most symptoms of secondary hyperparathyroidism are due to the underlying cause. People with vitamin D deficiency may notice muscle pain and weakness or pain in the bones.

In severe cases, they can develop osteomalacia (soft bones) that can cause fractures and bone deformity (in children, this is rickets).

How does secondary hyperparathyroidism cause bone disease?

Your bones are constantly changing. Some cells create new bone and cells that remove old bone. This process is known as “bone turnover.”

If you have secondary hyperparathyroidism, bone turnover is high. This means that the cells that remove the bone work faster than those that create new bone, which causes the bones to become weak and brittle. This can increase your chances of having bone pain and fractures.


There are several treatments to cure secondary hyperparathyroidism. These include some medications, surgery, and control of blood phosphorus levels.

  1. Drugs:

There are three medications for secondary hyperparathyroidism: vitamin D supplements, active vitamin D (or vitamin D analogs), and cinacalcet. If you have secondary hyperparathyroidism, talk to your healthcare provider about the proper treatment.

Vitamin D supplements:  You need active vitamin D to absorb calcium from your intestines into the blood.

Your calcium level decreases without enough active vitamin D, and the parathyroid glands release too much PTH. Therefore, you should take vitamin D supplements if your blood level (also called 25-hydroxy vitamin D) is too low.

Vitamin D analog: if your kidneys can no longer produce active vitamin D (also called 1,25-dihydroxy vitamin D). Your health care provider will tell you the type and amount of vitamin D best for you.

Cinacalcet:  Cinacalcet is a medication that acts directly on the parathyroid glands to reduce PTH in the blood.

Cinacalcet acts like calcium, so the body believes more calcium is in the blood. It is a pill that takes once a day and is only for dialysis patients. Cinacalcet may increase your chances of having low calcium levels in your blood.

  1. Surgery:

Parathyroidectomy is an operation that removes the parathyroid glands. This operation is only for very severe cases of hyperparathyroidism that can not be treated with medication.

  1. Check your blood phosphorus levels:

Because high phosphorus levels increase PTH release, it is essential to keep phosphorus in the blood in a normal range using diet and phosphate binders.