s secondary hyperparathyroidism and they treat people empirically for D deficiency (and presumed secondary hyperparathyroidism) as long as their calcium is within the normal range. In primary hyperparathyroidism Vitamin D and calcium are not indicated I guess until after surgery. I may take a holiday from D supplementation until my results come in -- I think I've taken enough D to hold off for a week.
The short answer is no, she's not correct.
I'm not a healthcare professional but in the course of learning more about my own PPTH I've read quite a few scholarly articles, and I have to say that the decision by your endocrinologist to wait and see because of a negative sestamibi scan seems quite absurd. A scan (be it sestamibi or ultrasound) is *never* used to diagnose primary hyperparathyroidism; it's just to aid the surgeon prior to operation. Your blood tests are unequivocal.
My cardiologist has sent me back to my internist twice for elevated calcium levels, 10.8 and 11. Twice the internist found high-normal calcium, 10.6 and 10.3, and elevated PTH, 96 and 82, but has not pursued it further. There is a very little osteopenia, high blood pressure, frequent urination (exams showed no reason to suspect prostate problems). I have decided to go to a group of local endocrinologists who concentrate on diabetes but some have an interest in PHPT.
I've just been diagnosed with primary hyperparathyroid disease. My calcuim level was 11.1 and 10.6. when tested again. My 24 hour urine calcuim was 305. My Parathyroid Intact number was 144.6.
I have 2 healthy kids now but would like to get pregnant again soon. My endocrinolist wants to do a wait and see approach with me since I'm only 31 years old and my sestambi scan was negative.
Hi Barb, thanks for the reply. I have already read parathyroid.com - lots of information, but that is obviously a site run by the doctor who makes his living doing the surgeries, so he definitely will not recommend wait and watch. The SEO done here is remarkable - there is more than one site and it pops up in search results everywhere. Other protocols do consider waiting and watching for asymptomatic patients, although most recommend getting the surgery if one is younger than 50 (I am 48).
Also remember that calcium AND PTH levels in normal patients are very constant from week to week, measure to measure... while those with primary hyperparathyroidism have calcium and PTH levels that go up and down from day to day, week to week. They are variable.
There is no medical reason to "wait 6 months and get more tests". The patient either has a parathyroid tumor or they do not.
Usually the calcium is high w/ primary hyperparathyroidism (caused by a tumor). So if your calcium is "normal" and PTH is high and vit D low - most commonly the PTH is high due to the low vit D --- aka secondary hyperparathyroidism. But if Ca is high-normal (10 or above usually) then early primary hyperparathyroidism is possible.
The laboratory values vary, that is typical of hyperparathyroidism, but in primary HPT, both PTH and calcium or ionized calcium are at the same time high normal or above the upper limit of the ref. range. If one is low and the other high, that is not primary HPT.
I have varying symptoms, but I have many diseases and thus I don't know if the symptoms are caused by the HPT. I have also CFS. My parathyroid hyperplasia will not be cut off.
PTH is concerning for primary hyperparathyroidism with an inappropriately normal PTH. Usually these are 20-30 or higher, but have seen cases like this when PTH is 10-20, calcium is high and the answer is primary hyperparathyroidism. These adenomas do not usually cause a lump or intermittent swelling sensation.
Would recheck PTH and check urine calcium excretion (24hour urine collection). Would also do neck ultrasound (by a good thyroid/parathyroid doc) to see if there is an adenoma.
I have elevated levels of calcium and PTH in my blood. When I read about the symptoms of primary hyperparathyroidism on Parathyroid.com, I found that my symptoms during several years fit well to primary hyperparathyroidism (although I have other diseases, too). Maybe I have had higher than normal calcium level even for many years. Nobody knows.
Last year I thought that there must be a strange cause for the flimmer. Now I suspect hypercalcemia. Infections have also been suspected.
If the calcium and PTH are both high - then this is primary hyperparathyroidism. There are rare syndromes of pituitary tumors and parathyroid tumors that coexist (MEN syndrome - in this case, MEN 1). The FSH would be high due to the pituitary problem. Checking other pituitary hormones would be helpful and consider a pituitary MRI.
However, there could be another explanation. The PTH could be high due to a vitamin D deficiency (commonly seen in the autoimmune disease called celiac sprue).
I have diagnosed with primary hyperparathyroidism. Yesterday my endo said that I may instead have secondary hyperparathyroidism. My ionized calcium is at the upper reference limit or a little higher, and my PTH is over the upper limit. According to a Sestamibi scan, I may have parathyroid hyperplasia. My vitamin D level has been 55-69 nmol/L (reference range 25-175) during 2012. How much is my vit. D level in ngrams/ml? I have been taking 25-50 microgrms (1000-2000IU?) vitamin D per day.
I'm 23, male. My endocrinologist told me I don't have primary hyperparathyroidism but rather I have secondary hyperparathyroidism because my calcium is falsely elevated in the blood reports due to elevated albumin.
What do you think ?
serum ca = 10.48 mg/dl (8.10 - 10.40) (10/10/12)
pth = 61.20 (15 - 68) (10/10/12)
albumin = 4.67 g/dl (3.5 - 5.5) (10/10/12)
*CORRECTED SERUM CALCIUM* = 9.94 mg/dl
serum ca = 10.58 (8.10 - 10.
It is classically taught that the diagnosis of hyperparathyroidism requires a high calcium and a high PTH level at the same time. Unfortunately, about 20% of patients will not follow this pattern, with some having normal calcium levels and high PTH (18%), while others have high calcium levels with normal PTH (2%)."
An elevated TSH and low FT4 indicates primary hypothyroidism. Your vitamin D levels are also too low.
this is early/mild primary hyperparathyroidism - would see an endocrinologist for complete evaluation to see if surgery vs observation is appropriate.
All of the bloodwork conducted by my PCP indicates Primary Hyperparathyroidism, but the bloodwork done by the second endo scares me and makes me wonder if it is multiple myeloma. I have read over Dr. Norman's sight numerous times and have learned way more than I ever cared to about the parathyroid glands. I wanted to post my labs out here to get other opinions, especially Dr. Lupo's.
Labs listed are in order of oldest to newest, starting in May of 2009.
I have recently been experiencing the following symptoms anxiety, fatigue, aching bones, nausea, and tiredness (tiredness especially after eating).
I have had the following lab results:
Ionic Calcium of 1.35 mmol/L (normal upper range to 1.25 mmol/l)
on a seperate day:
Serum calcium of 2.57 mmol/L (normal up to 2.55 mmol/L)
PTH = 3.3 pmol/L (normal range up to 6.4)
Phosphorous = 1.20 mmol/l (range=0.8-1.4)
Chloride = 107 mmol/l (range=98-106)
Is this hyperparathyroidism?
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