Secondary Hyperparathyroidism: What It Is and How to Manage It

Secondary hyperparathyroidism happens when the parathyroid glands make too much parathyroid hormone (PTH) because something else in the body is off. Most often it’s linked to chronic kidney disease (CKD), low vitamin D, or high phosphate levels. High PTH pulls calcium from bones and can cause bone pain, weak bones, and problems with calcium in the blood.

How it starts: kidneys failing to activate vitamin D and clear phosphate lead to low calcium levels in the blood. The parathyroid glands respond by producing more PTH. Over time the glands can enlarge and keep making PTH even when labs improve.

Common signs and simple checks

Look for bone pain, muscle weakness, itchy skin, and sometimes fractures. Lab tests reveal high PTH, low or normal calcium, high phosphate, and low active vitamin D (calcitriol). Doctors also use bone density scans and X-rays if needed. Regular lab monitoring is key if you have CKD or long-term vitamin D deficiency.

Treatments aim to lower PTH and protect bones. First-line steps include correcting vitamin D deficiency with supplements and reducing dietary phosphate. Phosphate binders taken with meals can cut phosphate absorption — common options are sevelamer or calcium-based binders. If PTH stays high, doctors may use calcimimetics like cinacalcet to trick the parathyroid into reducing hormone production.

When surgery or more aggressive steps are needed

If medical therapy fails and PTH stays very high or causes severe bone disease and itching, parathyroidectomy (surgical removal of some parathyroid tissue) is an option. The procedure can bring quick symptom relief but requires careful follow-up since calcium levels can drop too low after surgery.

Practical tips you can use now: follow a phosphate-conscious diet — cut processed foods, cola, and certain dairy if advised; take vitamin D as prescribed; keep scheduled blood tests; and tell your provider about any bone pain or muscle weakness. If you have CKD, coordinate with a nephrologist for a tailored plan.

Medication side effects and interactions matter. Calcium supplements can boost calcium but may increase vascular calcification risk in CKD if overused. Phosphate binders differ in side effects and pill burden, so talk options through with your care team. If you start a calcimimetic, expect monitoring for low calcium and possible GI symptoms.

Living with secondary hyperparathyroidism means regular checks and small daily choices that protect bones and heart. With the right mix of diet, vitamin D, phosphate control, and medicines, many people keep symptoms under control and slow gland overgrowth. If labs or symptoms change, act fast — early adjustments prevent bigger problems.

How often to check labs depends on disease stage. In CKD stages 3–5, doctors usually measure PTH, calcium and phosphate every 3–6 months and more often if numbers change or if you're on therapy. In dialysis patients checks may be monthly. Kidney transplant can improve the condition but sometimes glands stay overactive. Work with your team to set targets—your provider will balance bone health, calcium levels and heart risks.