Over time, PHP damages almost every part of the body. Depending on how severe the disease is, PHP may cause virtually no symptoms or it may create severe, life-threatening symptoms. Doctors use the phrase "stones, bones, groans, psychic moans, and fatigue overtones" to remember that PHP can cause kidney stones, osteoporosis (i.e. weak bones), abdominal pain (i.e. pancreatitis, reflux disease), mental issues (i.e. depression, irritability, worsening concentration, worsening short-term memory, "brain fog"), and fatigue or low motivation levels among other things. When calcium levels become dangerously high (i.e. 13-15 range), patients may present in hypercalcemic crisis where their organs are failing and they are in a comatose or near-comatose state. Fortunately, hypercalcemic crisis is rare. Currently, the most common way patients find out that they have PHP is during a routine blood test or evaluation for low bone density (i.e. osteoporosis).
PTH signals the body to absorb more calcium from food and also to break down bone in order to raise the blood calcium levels. In PHP, the PTH level is constantly high so the body is constantly losing calcium from the bones. Eventually, the bones can become weaker and weaker and patients are more and more at risk for fractures (i.e. broken bones). The strength of a patient's bones can be measured with a simple test called a bone density scan. In this test, a specialized X-ray measures the bone density at the hip, femur (leg), spine, and forearm. The strength of the bone is compared to a healthy 30-year-old adult's bone density and given a score called the T score:
- Normal: T score between 0 and -1
- Osteopenia: T score between -1 and greater than -2.5
- Osteoporosis: T score less than or equal to -2.5
The lower the T score, the higher the risk of breaking bones. In an extreme form of PHP a bone disease known as osteitis fibrosa cystica can develop, in which the bones become so weak that they become soft and deformed. Fortunately, this is a very rare problem. Studies done at Columbia have shown that within a year of a successful parathyroid operation, patients usually gain about 10% of their bone density back and in addition stop losing their bone density at the faster rate caused by PHP.
High blood calcium levels can lead to high urine calcium levels. High urine calcium levels can cause stones to form in the kidney. These stones can be quite painful as they pass through the urinary system. They can also cause infections, blood in the urine, and kidney damage. Approximately 15% of patients with PHP will develop kidney stones. After a successful parathyroidectomy, the risk of forming new kidney stones returns to baseline (i.e. patients have the same risk as the average person).
High calcium levels can affect every system in the body and lead to a variety of symptoms. These symptoms are often called "non-specific" because they can be caused by a number of different problems and are not specific or unique to PHP. In other words, just because a patient has parathyroid disease and these symptoms, it does not necessarily mean that their symptoms are caused by parathyroid disease or that these symptoms will get better after the parathyroid is removed. These symptoms may include:
- Fatigue/Lack of energy
- Lack of motivation
- Muscle weakness
- Joint pain
- Muscle pain
- Bone pain
- Worsening concentration
- Worsening short term memory
- Slower information processing ("brain fog")
- Worsening quality of life
Cardiac disease and shorter life expectancy
PHP may cause a number of problems with the heart and blood vessels that include hypertension (i.e. high blood pressure), coronary artery disease, atherosclerosis (i.e. hardening of the arteries), arrhythmias (i.e. abnormal heart rate), and left ventricular hypertrophy (i.e. enlarging of the heart). In turn these problems can lead to a higher rate of heart attack, stroke, and premature death.