Key takeaways
- Parathyroid hormone (PTH) treatment mainly treats hypoparathyroidism (too little parathyroid hormone). Symptoms can include tingling, muscle cramps, and in severe cases, seizures.
- Recombinant human parathyroid hormone (rhPTH) is given as an injection under the skin once or twice daily, or by a continuous infusion pump. Dosing starts low and is adjusted with regular blood tests, often alongside vitamin D supplements and lower dose calcium.
- PTH therapy can improve calcium control, reduce symptoms like fatigue and mental fogginess, and may support bone health with intermittent dosing. Side effects are often mild, but calcium can swing too high or too low, so close monitoring matters.
You have four small parathyroid glands in your neck that produce parathyroid hormone, which regulates calcium levels in your blood and bones. When the parathyroid glands do not function properly, disrupting production, minor to severe consequences can occur.
To treat the hormone imbalance when the glands are underproducing, parathyroid hormone (PTH) treatment is the typically prescribed therapy.
We discuss what PTH treatment involves, who can benefit from it, and what to expect during PTH to help you and your family make an informed decision about this therapeutic option.
Parathyroid dysfunction, or parathyroid disease, has two primary forms.
Hypoparathyroidism
Hypoparathyroidism happens when your parathyroid glands do not produce enough parathyroid hormone.
It has several causes, including accidental damage to the glands, surgery-related concerns, autoimmune disorders (occur when the body wrongly attacks the glands), or genetic conditions present from birth.
Low parathyroid hormone can lead to low calcium levels and high phosphate levels. These mineral imbalances can cause muscle cramps, tingling, and in severe cases, serious complications such as seizures.
PTH is the primary treatment.
Hyperparathyroidism
Hyperparathyroidism occurs when your parathyroid glands produce too much parathyroid hormone.
The condition causes bone cells that build new bone and remove the old to work too quickly. This can lead to bone pain, fractures, and a bone disease called renal osteodystrophy.
Hyperparathyroidism can be primary (overactive parathyroid glands), secondary (gland dysfunction linked to another condition), or tertiary (excessively overactive parathyroid glands). Prolonged secondary hyperparathyroidism can lead to tertiary hyperparathyroidism.
Primary and tertiary forms also cause elevated calcium levels, while the secondary type either does not affect calcium levels or leads to low levels.
Treating hyperparathyroidism can involve medication, radioactive iodine, and surgery. Your doctor will tailor a treatment plan based on your specific situation.
Parathyroid hormone treatment uses recombinant human PTH, essentially a laboratory-made version of the hormone your body naturally produces. Unlike orally administered pills, recombinant human PTH (rhPTH) is an injectable medication. Its administration method aids its effectiveness.
Subcutaneous injection
Your doctor can teach you how to give yourself an at-home
Typically, the injection is done on the thigh or abdomen once or twice daily. You can also administer PTH treatment with a continuous subcutaneous infusion pump. Doctors typically prescribe PTH therapy along with calcium supplements.
Dosing and monitoring
PTH treatment depends on your calcium levels. Starting doses are usually kept low until your doctor knows how you respond to it.
Your doctor will order regular blood tests to see how your body’s responding to therapy because everyone’s body processes PTH slightly differently.
While you’re receiving PTH treatment, your doctor might suggest that you continue calcium and vitamin D supplements, though typically at much lower doses than those prior to PTH therapy.
Your doctor will monitor you throughout the course of therapy. They will pay close attention to your calcium, phosphate, and sometimes vitamin D levels to ensure the treatment is working but not raising your calcium levels too high. They will make adjustments as needed.
The standard treatment for hypoparathyroidism is activated vitamin D (calcitriol) and calcium supplements. But maintaining balanced levels can be challenging, and there are potential side effects, such as calcium buildup in the kidneys.
PTH treatment offers a more physiological approach. It uses a synthetic version of PTH to mimic what healthy parathyroid glands naturally do, providing benefits to some individuals.
Better calcium management
PTH injections activate vitamin D in the kidneys, promoting calcium absorption from food in the intestines and encouraging the kidneys to retain calcium rather than excrete it. This can help your body better maintain stable calcium levels and reduce your need for high dose supplements.
Improved quality of life
While PTH treatment can lead to improved blood test results, often the most noticeable difference is how patients feel.
Treatment tends to reduce hypercalcemia symptoms. Patients receiving therapy often report improvement in symptoms like muscle cramps, fatigue, and mental fogginess.
The practical advantage of not having to take so many calcium and vitamin D pills each day can offer benefits. Fewer and smaller calcium tablets may reduce your risk of kidney stones compared to high dose supplements that can crystallize in your urinary tract.
Bone health benefits
When prescribing PTH treatment intermittently rather than constantly, experts have found that it stimulates new bone formation. This effect is not seen with calcium and vitamin D supplements.
Over time, new bone growth may improve bone density and reduce fracture risk, which can be particularly important for those who’ve lived with hypoparathyroidism for decades.
PTH therapy is usually well tolerated, but like any medical treatment, it can come with potential side effects.
Common side effects
Most side effects tend to decrease once a doctor finds the optimal dose for an individual. Additionally, many treatment-related concerns relate to the injection itself rather than medication side effects, with the most frequent being redness, mild pain, or swelling at the injection site.
You may also get headaches or feel nausea, especially when first starting treatment or during dose adjustment. Most side effects are mild and manageable.
Serious but rare concerns
More significant side effects are uncommon but worth understanding.
If calcium levels climb too high,
If hypercalcemia goes unrecognized and untreated, it could lead to nausea, vomiting, and muscle weakness. It can also potentially affect your heart rhythm or kidney function. Hypocalcemia (very low blood calcium) is also a potential concern and can cause twitching, cramping, and seizures.
Doctors carefully weigh these considerations when recommending treatment. They use constant monitoring to identify problems — treating them early on — to prevent them from becoming more serious.
PTH treatment is not a first-line therapy for everyone with hypoparathyroidism.
Ideal candidates
Prescribing calcium and vitamin D supplements is the standard recommended treatment for individuals with hypoparathyroidism.
However, those who have difficulty maintaining hormone balance with conventional therapy may be good candidates for PTH treatment. Additionally, if your test results look fine but you’re still experiencing low quality of life and bothersome symptoms despite treatment, your care team might recommend PTH therapy.
Sometimes high doses of vitamin D and calcium can cause complications, such as kidney stones or elevated calcium levels in urine. These individuals are also strong candidates for therapy.
It’s important to note that quality-of-life considerations matter too. For example, cost and insurance coverage are practical considerations, as PTH treatment can be expensive. Also, some people prefer the simplicity injections offer over pills, while others feel the opposite. Your doctor will also take your preferences into account.
Clinical scenarios
Some clinical situations can lead your doctor to discuss PTH therapy sooner.
For example, difficult-to-manage hypocalcemia that leads to frequent emergency room visits or hospitalization can indicate conventional therapy is not adequate.
Similarly, hypercalciuria (too much urinary calcium despite low blood calcium levels) can lead your doctor to consider PTH treatment, as this medical situation often responds better to PTH therapy than more supplementation.
PTH treatment represents an important advancement in managing hypoparathyroidism.
For those who have not found success receiving conventional supplement therapy, it offers a more physiological approach to restoring hormone balance, potentially improving both lab results and overall quality of life.
Still, PTH therapy is not the right choice for everyone. The key is working closely with your doctor, who can determine whether this therapy meets your medical needs, monitor your response carefully, and adjust treatment as needed.
If you’re living with hypoparathyroidism and have questions about your current treatment, talking with your doctor, including about PTH treatment, is important.