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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
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I am a bariatric patient, I am out eight years. I had labs done in April, by my bariatric labs done by my primary. My PTH was 125, which was high, and had been normal for the last 7 years. Do to the fact that my PTH was high, not realizing the implications of a bariatric patients tendencies toward secondary hyperparathyroidism, she ordered a Ultrasound. Which I am grateful for, because they found two nodules on my thyroid. So off we go to biopsy land, I had three, two at the hospital I work at and one by a ENT. All three biopsies showed nothing, but the one done by the ENT with and ultra sound discovered that they were parathyroid nodules and not thyroid nodules. He says surgery is needed to remove them. Meanwhile I went back to my nutritionist, at the bariatric clinic I had my surgery through, she had told me that it is due to my diet, which I agreed with, and now I am confused. Can I have both? Primary and secondary Hypothyroidism. My Calcium is normal, although on the high side of normal. I have always taken my vitamin D 5000 mg and my Calcium religiously. I feel I eat well, except milk product, as they seem to upset my stomach. They haven’t always, until recently. I do have many of the symptoms that are described especially the migrains, which I am being treated by a Neurologist for.
Hello, The distinction between primary and secondary is made based the finding of vitamin D, and calcium level and with the finding of any parathyroid nodules. What is the vitamin D level? Elevated (high normal) calcium may be more suggestive of primary disease than secondary due to bariatric surgery.
Hi Dr. K. My PTH recently skyrocketed up 50 points over the course of 4 months and is now at 147 and I’m concerned. . My vitamin D is 39 and my calcium is 8.1. I have now increased my calcium to 3000mg per day spread out through the day. I also take magnesium at a 1:2 relationship to calcium and I am taking 200,000 iu of vitamin D3. I am very concerned. What is the best way to get my PTH down? Also, I recently had a venofer infusions for 4 months-from December -April, during the same time period that my PTH rose rapidly. I’m wondering if there is any relationship. Would you know if the iron infusion could have impacted my PTH. My phosphorous dropped during the infusions-it didnt rise-and it is still in normal range. I was also not well for a month and not very active so I wonder if that contributed in any way also. Should I be concernd about osteoporosis? Any input on how to get my PTH under control would be appreciated. Thank you
Continue taking the vitamin D and Calcium. Make sure of the correct formulary. Please contact your surgeon directly. IF the PTH does not reposed then a workup needs tone done to makes sure there are no endocrine abnormalities of the PTH glands.
See your physician for detail review of the results and recommendations. In general need to keep the vitamin D at high level till the numbers get better and the PTH starts improving and all this may take some time
I am actually taking 100,000iu of the dry vitamin d -my error-and 2500 calcium per day -upcal d powdered calcium. Numbers are still high but came down slightly. Saw endo but she told me I was taking too much d-100k dry daily and wanted me to cut back. Endo also said I don’t fit the bill for endo abnormalities -according to questionnaire she filled out with family history etc-and she said no need to scan parathyroid. I’m just wondering if I can up vitamin d above 100k daily and also wondering if you do phone consults as I feel alone in this.
Please contact your primary care for detail instruction. You can also contact us.
I wanted to get the gastric sleeve done however I have a history of Hyperparathyroidism associated with hypercalcemia. Will I be turned away from the surgery. Or will I have to have a parathyroidectomy (had one in June 2017, it wasn’t successful because they only found one parathyroid, the other have yet to be located because I have yet to complete the testing in which is needed). I was doing the infusion of prednisone but stopped in Dec 2018. Been pursing the gastric sleeve and haven’t seen my endocrinologist since Dec. Last time I checked in May it was at level 11.5
There are clear cut algorithms for working up hyperparorthyrodism. Need nuclear scan, Vitamin D levels, and exploration of the neck and sternum for the glands prior to any weight loss surgery
Hi there. I had the DS in 2013. I have hyperparathyroidism and have been taking 200,000 iu of Vit D3 dry biotech a day and 2000 mg calcium citrate along with K2 daily. I was able to get my PTH down from 147 down to 100 (14-72 is Norma) and my vitamin D up from 38 to 85 in 7 months. My calcium, however, despite supplementation has gone down from 8.6 to 8.4 (8.7-10.2) and my ionized calcium remains below normal also at 1.13(1.15-1.32). Would it be a good idea to raise my calcium to 3000 mg a day and keep my D intake the same and is there a more absorbable calcium besides calcium citrate? Is there any other testing I should be having done.
Hello, the calcium and vitamin D and PTH tend to be slow responder to supplements. The fact that the PTH and the vitamin D are improving is a good indicator. There are other variable as to the calcium absorption that may not be clear. types of the supplements, the Magnesium level, food intake etc all play a role. You should have all this discussed and reviewed in private by your bariatric surgeon, endocrinologist or your primary care.
Hi I had the gastric sleeve 1 year ago and now my pth is 135. Should i be concern? My Gastic NP retired . Not sure what to do next