Q: Can you please talk about hyperparathyroidism in your column? We need to get the word out on high calcium in our blood and how sick it can make us. Doctors are missing this and so many people are suffering. It took me four different doctors to believe me after I went to my doctor for the blood test. They told me my calcium wasn’t that high (10.5) and my PHT test was normal, too (63.7). I finally found a doctor who believed I had this disease. I had a sestamibi scan that showed I had a tumor. I am having surgery next week. Doctors need to know that patients over 40 should NEVER have calcium over 10.2 in their blood!! It makes you sick. Most of the ranges at the lab say up to 11 is normal, that is if they are including children and teenagers.
Thank you so very much, let’s change the lives of others.
A: Hyperparathyroidism is a disorder in which the parathyroid glands in the neck produce too much parathyroid hormone (PTH). These glands are tiny, despite having such an important bodily function which is to control calcium, phosphorous, and vitamin D levels in bone and blood. Normal calcium levels range between 8.5 and 10.2 mg/dL. There are reasons for elevated levels, such as if a person consumes two or more quarts of milk daily, takes nutritional supplements or calcium-containing antacids, or is on specific medications. Higher than normal levels may be due to Paget’s disease, hyperparathyroidism, having HIV/AIDS, being on bed rest for an extended period of time, and more. Normal PTH levels are between 10 and 55 picograms per milliliter. Levels above 55 are considered high and may be because of a parathyroid tumor, a vitamin D disorder, a lack of calcium, swelling of the parathyroid gland, and more. Remember that hospitals and health care facilities may have different standards for testing, so it is important that you speak with your physician for his or her input of figures that appear to be outside the range of “normal”.
There are two types of hyperparathyroidism – primary and secondary. The primary form causes excess production of the hormone and results in higher-than-normal levels of calcium in the blood. The condition known as hypercalcemia may occur because of a benign adenoma on the gland, enlargement of two or more of the parathyroid glands, or rarely, because of the presence of a malignant tumor. The secondary form is the result of other conditions that results in excessively low levels of calcium in the body. Causes may include a pronounced vitamin D deficiency, chronic renal failure,or because of a serious deficiency of calcium. Those at an increased risk include individuals who have undergone radiation to the neck area for cancer, bipolar patients who have been prescribed lithium, post-menopausal women, those individuals who have had partial or complete surgical removal of the parathyroid gland, and still others with extreme vitamin D or calcium deficiencies.
Symptoms of parathyroidism include anorexia, nausea, vomiting, limb deformity, abdominal pain, kidney stones, bone and joint pain, cortical bone loss, bradycardia, depression, memory loss, and chondrocalcinosis (a type of arthritis in which calcium deposits are found in the joints of the hands and feet. The latter symptom is commonly found in patients over the age of 50 who have diabetes or osteoarthritis.
Diagnosis is commonly made through laboratory testing. Blood work may confirm or rule out elevated calcium and parathyroid hormone levels; urine testing will identify how much calcium is excreted through the urine. X-rays and other imaging tests such as a sestamibi will not aid in reaching this diagnosis but may be ordered to determine if osteoporosis, another tumor, or other conditions such as kidney abnormalities exist.
Depending on the extent of the hyperparathyroidism, a physician may choose to monitor you or may feel surgery is your best option. Surgery successfully cures about 90% of all patients with the diagnosis of primary parathyroidism. Medication may be prescribed and can include bisphosphonates used to prevent the loss of calcium from bones, or mimic drugs such as Sensipar which has been approved by the FDA to treat the disorder when it is caused by chronic kidney disease or parathyroid cancer. Hormone replacement therapy (HRT) may be ordered for post-menopausal women. Of note is that extended use of HRT may increase the risk of some types of cancer and cardiovascular disease.
When symptom-free, minimal increases in calcium levels may allow a patient to choose exercise, avoid taking diuretics (water pills), and increasing their fluid intake to prevent kidney stones from forming. Exceedingly high levels may require surgery to remove the gland that is overproducing. Secondary hyperparathyroidism therapy depends on the cause and may respond to prescription vitamin D if levels are low or surgery for any malignant lesions. If caused by kidney failure, a patient may take supplemental calcium with vitamin D, avoid dietary phosphates, consider dialysis, kidney transplant, be prescribed Sensipar, or parathyroid surgery. Because of the wide variations of this disorder, your nephrologist will guide you toward making the best decisions for control.
