Hyperparathyroidism
Treatment — Houston, TX
Primary hyperparathyroidism is the most common cause of elevated calcium in outpatients — yet it often goes unrecognized for years. Our board-certified endocrinologists in Houston provide expert evaluation, medical management, and surgical coordination for this condition.
Quick Facts
What Is Primary Hyperparathyroidism?
Primary hyperparathyroidism (PHPT) occurs when one or more of the four parathyroid glands becomes overactive and secretes too much parathyroid hormone (PTH). This drives calcium out of bones and into the bloodstream, resulting in persistently elevated blood calcium (hypercalcemia).
It is the third most common endocrine disorder after diabetes and thyroid disease. The vast majority of cases — approximately 95% — are caused by a single benign parathyroid adenoma that can be surgically removed with excellent outcomes.
As endocrinologists, we are the appropriate specialists to diagnose PHPT, distinguish it from other causes of hypercalcemia, determine whether surgery is indicated, and manage patients medically when surgery is not the right option.
Kidney Stones
Calcium oxalate or phosphate stones from excess calcium in the urine
Bone Loss
PTH-driven bone resorption leads to osteopenia and osteoporosis
Fatigue & Depression
Chronic hypercalcemia causes low energy, mood changes, and brain fog
GI Symptoms
Nausea, constipation, and abdominal discomfort or pain
Excessive Thirst
Polyuria and polydipsia from calcium's effect on the kidney
Asymptomatic Finding
Up to half of patients are diagnosed incidentally on routine labs
Primary vs. Secondary vs. Tertiary
Not all hyperparathyroidism is the same. Distinguishing the type is critical because treatment differs completely:
Primary Hyperparathyroidism
The parathyroid gland itself is overactive — most commonly due to a single benign adenoma. PTH is elevated or inappropriately normal alongside high calcium. This is the most common type seen in our practice and the main focus of this page.
Secondary Hyperparathyroidism
PTH rises as a response to chronically low calcium or Vitamin D deficiency — most commonly in chronic kidney disease. Calcium is low or normal (not high). Treatment targets the underlying cause: Vitamin D repletion, phosphate management, or dialysis optimization.
Tertiary Hyperparathyroidism
Occurs when long-standing secondary hyperparathyroidism causes the glands to become autonomously overactive, resulting in elevated PTH and high calcium — often after kidney transplant. May require surgical intervention.
How We Diagnose & Manage Hyperparathyroidism
Confirm the Diagnosis & Rule Out Mimics
We confirm elevated calcium and PTH on repeat testing, calculate 24-hour urine calcium to exclude familial hypocalciuric hypercalcemia (FHH) — a benign genetic mimic — and review all medications and supplements that can affect calcium.
Assess End-Organ Damage
We evaluate for the consequences of PHPT: kidney stone history, 24-hour urine calcium, renal ultrasound when appropriate, DEXA bone density scan (all three sites: spine, hip, and distal radius), and eGFR to assess kidney function.
Determine Whether Surgery Is Indicated
Using current Endocrine Society guidelines, we evaluate whether your calcium level, age, bone density, kidney function, and symptoms meet criteria for parathyroidectomy. Surgery is curative in over 95% of cases and is the only definitive treatment for primary PHPT.
Surgical Coordination or Medical Management
For surgical candidates, we coordinate with experienced endocrine surgeons and provide pre- and post-operative endocrine management including monitoring for post-surgical hypocalcemia (hungry bone syndrome). For non-surgical patients, we provide structured monitoring with calcium, PTH, DEXA, and kidney function at guideline-recommended intervals, and may prescribe cinacalcet for symptom management when appropriate.
Physicians Who Treat Hyperparathyroidism
Texas Super Doctors Rising Star
Related Education Resources
Hyperparathyroidism FAQ
I was told I have "mild" hyperparathyroidism and don't need treatment — is that right?
Sometimes. Asymptomatic PHPT with mildly elevated calcium can be monitored without immediate surgery — but only if you do not meet any surgical criteria, including age under 50, significantly elevated calcium, reduced bone density, kidney disease, or kidney stones. Regular monitoring by an endocrinologist is essential because PHPT can progress, and missing evolving complications is a real risk without structured follow-up.
Is parathyroid surgery safe?
In experienced hands, minimally invasive parathyroidectomy has a cure rate above 95% and a very low complication rate. The main risks are transient low calcium after surgery ("hungry bone syndrome") and, rarely, damage to the recurrent laryngeal nerve. We work with experienced endocrine surgeons and provide careful post-operative monitoring.
What is "hungry bone syndrome" after parathyroid surgery?
After removal of an overactive parathyroid gland, the skeleton can rapidly absorb calcium as bones begin to re-mineralize — causing a significant drop in blood calcium. This is most common in patients with substantial pre-operative bone loss. We monitor calcium closely after surgery and provide supplementation to manage this safely.
Can medications treat hyperparathyroidism without surgery?
Cinacalcet (Sensipar) is a calcimimetic that lowers calcium levels by making the parathyroid gland more sensitive to calcium. It does not lower PTH as effectively as surgery and does not improve bone density, but it is useful for patients who cannot or choose not to undergo surgery. Bisphosphonates can be added to protect bone density in non-surgical patients.