Hyperparathyroidism and Weight Loss Surgery
Hypoparathyroidism refers to elevated level of parathyroid hormone levels (elevated or high PTH). Parathyroid glands are two small glands that are located behind the thyroid gland. The primary function is regulation of the calcium level in the bloodstream. Parathyroid levels may be abnormally elevated for a number of reasons.
There may be abnormalities within the parathyroid glands themselves including benign and malignant tumors. Laboratory studies to assist in identifying Parathyroid hyperplasia are calcium, phosphorus, magnesium, PTH (parathyroid hormone), Vitamin D and possibly a 24 hour urine, kidney x-ray, and Dexa scan. The calcium levels in parathyroid hyperplasia are usually elevated and Vitamin D levels low. Patients can present with hypercalcemia symptoms such as kidney stones, nausea, vomiting, peptic ulcer, constipation, bone pain, bone weakness, depression, lethargy, fatigue. There are two types of Primary Hyperparathyroidism parathyroid hyperplasia and parathyroid adenomas. These both can at times be genetically linked.
Once the cause of elevated parathyroid hormone has been identified as primary hyperparathyroidism, the treatment involves surgical removal of one or more of the adenoma(s) or removal of 3.5 off all of the parathyroid glands if hyperplasia is diagnosed.
Parathyroid hyperplasia: When the growth involves all 4 of the glands. These may effect either one of the glands or all 4 of them. Majority of these are benign.
Parathyroid adenoma(s) refers to the abnormality or benign growth of one or more of the parathyroid glands.
2- Secondary Hyperparathyroidism
This is probably the most common cause of hyperparathyroidism imposed on a weight loss surgical patient. The elevated parathyroid hormone is the physiologic response all of the parathyroid glands to low calcium level. The parathyroid hormone is elevated in order to favor bone breakdown and make available for calcium to be circulating in the bloodstream. Parathyroid hormone also facilitates reabsorption of the calcium from the urine and improve absorption of the calcium from the GI tract.
The most common causes of secondary hyperparathyroidism is Vitamin D deficiency, weight loss surgery, kidney failure, Celiac or Crohn’s Disease. Lower levels of Vitamin D decrease the intestinal calcium absorption and thereby increasing PTH secretion. Vitamin D is the transport molecule for calcium. Symptoms may include bone or joint pain, muscle weakness, osteomalacia, low to normal blood calcium levels. The treatment of secondary hyperparathyroidism is correction of the underlying low calcium, low vitamin D levels. We have our Duodenal Switch patients take calcium citrate and dry water miscible type of Vitamin D3. Some people may require vitamin D injection in order to overcome deficiencies. You can find a list of supplements on our website and/or our starting point supplement recommendation in our patient workbook