This graph shows the age breakdown in a different
format. The pie chart is from 15,000 patients operated on at our
center for parathyroid tumors. It is easy to see that most
parathyroid patients are between 45 and 75 years of age, but
patients in their teens, twenties and those in their 80's and 90's
get hyperparathyroidism. Patients of all ages benefit from having their parathyroid
tumor removed. Again, the average age is just under 60 years. This
pie chart is identical for men and women.
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If you find this page interesting, then you will enjoy a video
lecture by Dr Norman on this topic. Click Here.

Parathyroid Disease in Teenagers
There
isn't much written about the occurrence of parathyroid disease in
teenagers because it doesn't happen very often. But it does happen!
Usually teenagers will be diagnosed with hyperparathyroidism after some
"event" occurs and they get blood tests. This event is often a
kidney stone, a broken bone, or the onset of severe high blood pressure.
This leads to the doctors getting blood tests which show a high calcium.
The diagnosis of parathyroid disease in teenagers is usually very easy
once the doctors do the right tests. Usually it is not subtle, it is very
obvious with high calcium and PTH levels. A lot of teenagers with
hyperparathyroidism will have
calcium levels in the 12 - 13 range, thus there is usually no question
about the diagnosis even for doctors who have never had a patient with
this disease. Be warned, however, since your doctors have never seen a
case of parathyroid disease in a teenager they will do all sorts of tests
to look for other problems. After doing lots of x-rays, and blood tests
they will be left with the obvious... high calcium levels are due to a
parathyroid problem. Geeeezzzz, I wish they would just read this page.
Young patients who don't present after an "event" (kidney
stones, broken bone, etc) will often present to the doctor complaining
of recurrent
headaches, high blood pressure, or failure to grow. Lots of them go from
being good students to poor students who can't concentrate at school. Some teenagers have headaches that occur
monthly or weekly--and their parents or doctor will think that its due to
stress from school or other teenager-type stresses. But if the doctor gets
a calcium level it will become clear. Often, the physician will notice that a
young teenaged child has stopped growing (they were doing fine but never
got a growth spurt). Sometimes the teenager is actually put on growth
hormone (their doctor isn't looking for something as simple as a
parathyroid tumor). Routine labs will show a high calcium and the
diagnosis should be made--as long as the doctor is looking at the labs and
realizes that a high calcium level is never normal. Teenagers with
parathyroid disease are often (but not always) thinner than their
peers. Parathyroid disease in children can also cause a problem with the
formation of teeth, and the bones of the jaw may become week. It is
important to remove the parathyroid tumor as soon as it is found in these
children so that their growth is not stunted too long. All teenagers with
parathyroid disease should have x-rays of their bones to see if the growth
plate of the bones has closed... so treatments may be aimed at getting the
patient up to their correct height as soon as possible.
Often physicians treating a teenager with hyperparathyroidism will run
tests on other endocrine glands, specifically the pituitary, the adrenal
glands, the thyroid and the pancreas. These tests are performed because
the doctors are concerned that the teenager with parathyroid disease may
actually have a MEN syndrome (Multiple Endocrine Neoplasia Syndrome) which
is a genetic disease that causes tumors to occur in multiple endocrine
glands in one person. Parathyroid.com has several pages on MEN
Syndrome.
Despite the physicians getting all worked up about the possibility of
the teenage patient having a MEN syndrome, they rarely do! That's
right... it is so uncommon that you should not worry about it. Let your
doctor do the tests on the pituitary and the adrenal (etc) so this is ruled-out,
then get the parathyroid tumor removed. (Note we do not do these tests
because they are not necessary, and will waste time and money). Again, over
97% of teenagers will
have a single bad parathyroid gland as the problem, not 4-gland
hyperplasia. The other 3% will have 2 adenomas or 4-gland
hyperplasia. Although your doctor (endocrinologist) may say that
teenagers are most likely to have a problem with all four parathyroid glands, this
is not true. We have the largest experience of teenage
hyperparathyroidism in the world (by far) and our data shows that the
incidence of more than one parathyroid tumor is actually dramatically lower in patients
under 20 years of age. However, we strongly believe that teenagers need to
have all four parathyroid glands examined (in fact, we do this with almost
every patient we operate on). Find an expert surgeon who performs mini-surgery that involves
physiologic measurement of parathyroid activity during the operation (such
as a MIRP procedure) and this 4-gland measurement should take less than 20
minutes (the entire operation).
Once the parathyroid tumor has been removed you can expect that the
headaches will stop within the first month or so. Bone pain goes away in a
few hours. The high blood pressure
will usually go away in about 2-6 months. An enlarged (hypertrophied)
heart muscle will usually go away in 6 months to two years. Bone
density will increase rapidly and bone growth will begin immediately
provided the growth plates have not closed yet.
Bottom line... teenagers do get hyperparathyroidism... we operate on a
teenager every 2 weeks or so. The biggest problem is to get your doctors
to understand this and make the diagnosis... without spending $100,000 on
worthless x-rays and tests for other diseases that are NOT present. Again... this is simple... high calcium = bad parathyroid gland =
simple operation = get your life back!
You should
read the story at the end of this page that shows what a teenager went
through with hyperparathyroidism.

Parathyroid Disease in People in Their Twenties and
Thirties
Parathyroid
disease in 20-somethings and 30-somethings is not as rare as many doctors
would have you believe. Yes, it is much less common (about 1/6 as common) as
parathyroid disease in the 50's, 60's and 70's, but that means thousands
of people in their twenties and thirties will get parathyroid disease in the
U.S. every year. Many of the same things can be said for people in their
20's and 30's who develop a parathyroid tumor as can be said for patients
in their teens. They often are diagnosed after a trip to the emergency
room with a kidney stone, a bad headache which reveals high blood
pressure, a broken bone, or some other symptom of parathyroid disease. Yes
EACH of these symptoms are due to the parathyroid tumor causing the
release of calcium out of the bones into the blood.
Just like parathyroid disease in the teenage years, when it occurs in
the 20's and 30's, physicians often will begin to "jump through
hoops" looking for all sorts of bizarre and rare endocrine problems
that can be associated with the parathyroid problem. However, just like in
teenagers, the chance of one of these other associated endocrine problems
occurring is quite rare. Let the doctor do his/her tests, and then rest
assured that you have simple parathyroid disease and then get it fixed
with mini-surgery. DO NOT BELIEVE YOUR DOCTOR IF HE/SHE SAYS THAT YOU MUST
HAVE ALL FOUR PARATHYROID GLANDS REMOVED just because you are
young. We hear this garbage all the time from endocrinologists who have
never seen a parathyroid gland in their life. All patients can and should
be fixed with mini-surgery in an out-patient setting. (read
more about min-surgery). If your doctor is making this difficult or
dangerous, then get a different doctor. Hyperparathyroidism is a simple
disease and its easy to cure.
One interesting thing about hyperparathyroidism in young patients is
that women in this age group can become pregnant while they have
parathyroid disease. This presents very special problems for both the
patient and the mother--which can be life-threatening. We have an entire
page on Hyperparathyroidism During Pregnancy
so it is not discussed any further here.

Parathyroid Disease in People in Their Forties and
Fifties.
As
you can see from the graph above, parathyroid problems become more common
once people get into their 40's and 50's. The most frequent way that
hyperparathyroidism is found in this age group is when a routine blood
test shows a high calcium. Once people get into their 40's and above, they
tend to see a doctor almost yearly. This is a little more true for women
who are seeing their family doctor or a gynecologist for their yearly PAP
exams and mammograms. Men also tend to get regularly scheduled physicals.
Usually, the yearly physical exam that is performed by these doctors will
include blood test such as cholesterol, red and white blood cell count,
liver function tests and electrolytes. Sometimes the lab will include a
calcium level with these tests (depends on if the doctor orders it this
way). If your doctor is 'on the ball', he/she will notice the high calcium
and have that test repeated again... if it is high again, they will order
a parathyroid hormone test (PTH). If the calcium is high and the PTH is
high, then you have hyperparathyroidism (click
here to read more about the criteria for diagnosing hyperparathyroidism).
The second most common way that parathyroid disease is diagnosed in
patients over the age of 40 is when the patient goes to their doctor
complaining of: tiredness, irritability, depression, lack of energy, poor
sleeping, loss of sexual desire or one of the other symptoms
of parathyroid disease. The doctor will order blood tests and the
calcium will be elevated. Sadly, many doctors won't recognize the high
calcium as a cause of these problems, and the patients will be put on an
anti-depressant (Effexor, Prozac, Wellbutrin, Zoloft, Celexa, Lexapro,
Paxil, Serzone). About 60% of parathyroid patients between the age of 30
and 50 will have been put on an anti-depressant (or talked about starting)
some time in the previous 2 years (so don't feel alone). The good news
that within 1-3 months after getting the parathyroid fixed, almost all
patients can be taken off of the antidepressant. The high calcium caused
this problem!
Other common ways that parathyroid disease is found in this age group
is by the early onset of osteoporosis or when a kidney stone or broken
bone occurs. Blood pressure problems are also a key event that causes the
doctor to get blood tests--this is also caused by the high calcium. When
the parathyroid tumor is removed, the vast majority of people with high
blood pressure will be able to stop one or more of their blood pressure
medications, and some can be taken off blood pressure medications
completely.

Parathyroid Disease in People Over the Age of Sixty.
Parathyroid
disease in patients over 60 is very similar to what is seen in patients
between 40 and 60. However, in this age group the emphasis is often on the
health of the bones (severe osteoporosis) or the health of the mind.
Osteoporosis will occur in ALL patients with parathyroid disease given
enough time (a few years). As more and more people (especially women) are
getting DEXA bone scans to look at the density of their bones, doctors are
discovering osteoporosis that is worse than they expected. If they check a
calcium level, they can make the diagnosis of parathyroid disease which is
causing the osteoporosis. Importantly, there are NO DRUGS that
will help osteoporosis caused by a parathyroid tumor... Not Actonel, and
not Fosamax. This is not debatable. Luckily, the
osteoporosis caused by parathyroid disease is reversible--and it will
start getting better the day after the parathyroid tumor has been removed.
All the patient has to do is take about 1 gram of calcium per day and a
multi-vitamin.
Depression and constant tiredness are very common symptoms for people
of all age groups, but especially in those over 40, and even more often in
people over 60. Their loved ones
will typically say... "she was doing great until a couple of years
ago and then she has just gone down hill since then". These symptoms
will hopefully get your doctor to order some blood work and not just
prescribe some anti-depressants. Fixing the
parathyroid will often (almost always) bring back the excitement and
enjoyment of life for these patients. Importantly, after the parathyroid
tumor has been removed, almost ALL patients who are on ant-depressants
won't need these medications any longer.
Of course, patients over the age of 60 will also be discovered to have
parathyroid disease after an attack of kidney stones, or when
"nothing" is really wrong until a routine blood test shows a
high calcium.
REMEMBER... It doesn't matter how
old you are, virtually everybody can have a mini-operation that takes 20
minutes or so... performed as an out-patient where you go home about an
hour later. Make sure you find an expert surgeon who does a lot of these
operations and you can have your problem cured in one morning! If they say
it may take 3-4 hours and you have to spend the night in the hospital (or
2, or 3!!), then you know they don't perform many parathyroid
operations... go somewhere else. If your surgeon isn't performing
parathyroid surgery at least once per week, then don't let them be your
surgeon.

Parathyroid Disease in People Over the Age of Eighty.
We
operate on patients over the age of 80 every day (actually, we average
almost 2 per day over the age of 80, and about one every two weeks over
the age of 90). We have recently
published a scientific paper showing how well these patients do, and how
much better they feel after they had their parathyroid tumor removed. When
we look at these patients closely, it is apparent that they had
parathyroid disease while they were in their 70's, but one of their
doctors said to them "let's just watch it, your calcium is not that
high". That is miserable advice. As you know by now, the
disease is caused by a tumor. The tumor will not go away. It will not get
smaller. It will only get worse. It will not stay the same. And as the
patient gets older, the tumor gets bigger and the symptoms worsen... and
the bones get worse!!!. So, after these patients have had high calcium for
a handful of years, they finally go to a new doctor (like a cardiologist)
who finally stops the nonsense and realizes that it is the high calcium
that is causing the heart problems and tells the patient that they must
get the tumor removed. Do NOT let the fact that you are over 80 years of
age be a factor that says you can't have surgery. Sure you can, if you
pick your surgeon wisely! Find a surgeon that can do the operation in 30
minutes or less (there aren't many of these surgeons), and get the darn
tumor removed! Our data on hundreds of patients over 80 shows that the
cure rate is over 99% and the procedure usually take less than 18 minutes.
Dr Politz led this study showing how safe it is to operate on patients
over 80 and send them home within 2 hours, since the operation was so
small and simple. These older patients feel much better when the tumor has
been removed. In 1/3, their atrial fibrillation goes away! The citation
is: Hyperparathyroidism in patients over 80: clinical characteristics
and their ability to undergo outpatient parathyroidectomy. Thyroid.
2007 Apr:17(4):333-339.

Folks, the following letter is from a 22 year old
young lady who had parathyroid disease from the age of 15. This is quite
uncommon, but it does occur. Her doctors simply "watched" her
high calcium levels while it ruined her life. Please read this and
learn... and maybe help your doctors learn. This is a heart-warming story
that you will like.