Hyperparathyroidism: A Potential Underlying Cause of Anxiety, IBS, and Fatigue

Struggling with anxiety, fatigue, constipation, bloating, or gas? While it seems that these symptoms are often deemed to be normal, I’m here to tell you that they’re not and may actually be a sign that you should have your Doctor do further investigation.

While one of the causes may be your parathyroid, it can also be caused by a slew of other conditions including but not limited to your thyroid, hormonal imbalances, adrenal issues, or blood sugar dysregulation.

Interestingly enough, anxiety disorders are the most common mental illness in the United States, affecting over 18% of the U.S. adult population. That is a huge statistic that seems to be rising each year. While anxiety disorder is very often considered a diagnosis and treated with SSRIs and SNRIs, what if it is actually a symptom of an underlying condition?

Rather than merely masking your anxiety, it may be prudent to investigate the root cause of your symptoms. Yes, there can be many causes of anxiety, and while medications or other therapies may be necessary in some cases, they may be masking the root cause of your anxiety. Some causes of anxiety may include:

• Trauma
• Stress
• Pregnancy
• Genetics
• Drug side effects
• Chemical Imbalances
• Nutrient Deficiencies
• Hyperthyroidism
• Hyperparathyroidism

There are many benefits to treating the potential underlying cause of your symptoms. Not only can you avoid being on medication for the rest of your life, but you may also be able to avoid side effects to some of these medications and symptoms and risks associated with some of these other conditions. 

What is your parathyroid?

Your parathyroid glands are 2 pairs of small, 4 pea-sized, oval-shaped glands that sit next to your thyroid gland, which is located in your neck.

What do your parathyroid glands do?

Your parathyroid glands produce parathyroid hormone (PTH), which very closely regulates the calcium levels in your bloodstream. Specific areas in your body, like your kidneys, small intestine, and bones respond to PTH released by the parathyroid glands by increasing the calcium levels in your blood.

Parathyroid Hormone also helps regulate intestinal absorption of calcium, how much calcium your kidneys hold onto, and helps with the transformation of Vitamin D to its active form. 

What makes calcium so important?

Calcium is one of the most abundant minerals in your body that provides many vital functions. Calcium is an extremely essential mineral when it comes to the strength of your bones and teeth, cardiovascular health, muscle contraction, blood clotting, and nerve function.

Most of your calcium is stored in your bones, but about 1% is found in your blood, muscles, and other tissues. Your body tightly regulates the calcium in your body, specifically the amount of calcium floating around in your blood. Your body does this to avoid hypercalcemia, which can lead to weak bones, and kidney stones and potentially create cardiovascular emergencies. 

What else regulates your calcium?

Your PTH and calcitonin regulate your calcium. PTH, also known as Parathyroid Hormone, is a hormone that your parathyroid glands produce and release to help control the amount of calcium circulating in your blood.

PTH stimulates the release of calcium into the blood, and also helps control the levels of both Vitamin D and phosphorus. When PTH levels are elevated, it can cause your serum calcium levels to rise. 

Calcitonin, on the other hand, is a hormone made by and released by parafollicular cells in your thyroid gland. Calcitonin helps regulate the calcium levels in your blood, preventing calcium in your blood from getting too high.

It does so by blocking the activity of osteoclasts, which are cells that are responsible for breaking down your bones. Preventing bone breakdown helps reduce the amount of calcium that gets released into the bloodstream. 

What is hyperparathyroidism?:

Hyperparathyroidism is when your parathyroid glands create too much parathyroid hormone (PTH)  in the bloodstream. There are two types of hyperparathyroidism- primary and secondary, indicating different etiologies.

In primary hyperparathyroidism, an enlargement of one or more of the parathyroid glands causes overproduction of the hormone. This causes high calcium levels in the blood, which can cause a variety of health problems. Surgery is the most common treatment for primary hyperparathyroidism.

Secondary hyperparathyroidism occurs due to another disease that first causes low calcium levels in the body. Over time, increased parathyroid hormone levels occur.

How can hyperparathyroidism cause anxiety?: 

When an individual has hyperparathyroidism, they have an excess amount of calcium in their blood, called hypercalcemia. Too much calcium in the blood will affect the nervous system, leading to a slew of nervous system conditions, including anxiety, forgetfulness, brain fog, and depression.

Interestingly enough, a study compared patients with hyperparathyroidism with a control group and found that the incidence of anxiety was higher in the subjects with hyperparathyroidism. Even more interesting was that once the subjects with hyperparathyroidism were treated with a parathyroidectomy, the incidence of anxiety decreased! About half of patients with hyperparathyroidism suffer from anxiety, and clinically, research is proving that higher blood calcium levels (hypercalcemia) are linked with anxiety. 

Hyperparathyroidism and depression:

Because elevated blood calcium levels have been shown to affect the nervous system, we see that not only does this cause anxiety, but may even be linked to depression in some individuals. A study looked at almost 400 patients with hyperparathyroidism over the course of several years.

The incidence of depression was found in about 10% of the patients. What's even more interesting is that after this set of patients underwent parathyroidectomy, 90% of those patients said that their symptoms of depression were no longer impacting their quality of life and ability to work. 

Hyperparathyroidism and IBS:

Given that the parathyroid glands regulate your plasma calcium levels, they’re able to have an influence on your digestive tract. Too much calcium due to hyperparathyroidism can cause gastric upset, including constipation, nausea and heartburn. Interestingly, some complications of hyperparathyroidism may include kidney stones (also known as nephrolithiasis), peptic ulcers, pancreatitis, and dehydration.

So if you're having IBS symptoms like abdominal pain, diarrhea, constipation, and bloating, make sure your Doctor rules out all other causes, including hyperparathyroidism, before diagnosing Irritable Bowel Syndrome (IBS). 

Hyperparathyroidism and fatigue:

Excess calcium in your blood will cause calcium to be leached out from your bones, causing bone weakness which predisposes you to fracture, bone and muscle pain. But as we mentioned earlier, it affects not only your bones but also your nervous system. Too much calcium in your blood interferes with your brain function, oftentimes causing memory loss, confusion, and fatigue. 

So now what? If you are experiencing any of these symptoms, like fatigue, depression, anxiety, abdominal pain, weak bones, or constipation- ask your Doctor to check your parathyroid! This can be first assessed through a standard blood test called a Complete Metabolic Panel or a CMP. This panel will look at your blood calcium level. Even if your calcium levels come back normal, this does not exclude a parathyroid condition.

You should also ask your Doctor to assess your PTH, also known as your parathyroid hormone. This will give a better indication if you need further evaluation. At that point, your Physician might order a SPECT scan, which is a CT scan that allows for a better visual of your parathyroid glands.