Tag: PTH
Types of HyperParathyroidism
February 20, 2026 4:05 pm
There are 4 parathyroid glands which are located behind the thyroid gland, among other functions, are the main regulators of calcium, phosphorous, and magnesium in the blood. Elevations of parathyroid hormone (hyperparathyroidism) can be: 1-Primary, 2-Secondary, 3-Tertiary
Primary hyperparathyroidism means the parathyroid glands themselves are hyperactive. This may involve only one of the four glands: a) an adenoma, a benign tumor that needs surgical removal, or b) hyperplasia, when all 4 glands are hyperactive and/or enlarged, and in some cases, most of the 4 glands need to be removed.
Secondary hyperparathyroidism means that the elevated PTH level is caused by an external regulatory stimulus, such as low calcium, which itself may be due to low vitamin D, low calcium intake, or other causes.
Tertiary hyperparathyroidism is seen only in specific renal failure and transplant patients.
Regardless of the type of hyperparathyroidism, the end result is the same. Because the parathyroid gland aims to maintain normal calcium levels, it will do everything to achieve them. This includes increasing calcium absorption from the GI tract, breaking down bone to increase the blood calcium supply, and increasing calcium reabsorption from the urine.
Distinguishing between primary and secondary is critical, as primary is more likely than not a surgical problem that needs to be addressed. Secondly, it may be responding to metabolic deficiencies (low CA, low Vitamin D) that need to be corrected and take some time.
Not all cases require surgical intervention, as labs (vitamin D, calcium, and alkaline phosphatase) and imaging studies, such as neck ultrasound, CT scan, and Sestamibi scan, provide the information needed to dictate the treatment plan. Please stay up to date with your yearly lab results to catch changes sooner rather than later.
Magnesium Questions
May 11, 2016 6:07 am
Since our Webinar on Magnesium, I have received several Magnesium Questions recently regarding Magnesium deficiency. There is some evidence that calcium deficiency can not be corrected with an underlying magnesium deficiency. This may be due to the fact that magnesium is essential to converting Vitamin D to it’s active form and more information here. The active form of Vitamin D is needed to actively transport Calcium within the cell. This may be the confusion that calcium absorption needs magnesium. It is not needed directly but rather indirectly via Vitamin D.
Other cofactors needed in Vitamin D metabolism are:
Zinc (high doses antagonist with Magnesium and Copper)
Boron (raises Magnesium blood levels)
Vitamin K2
Vitamin A in small amounts
Further information regarding bone health and nutrients here.
Some important facts about Magnesium are:
- It is Absorbed in the distal Jejunum and Ileum (small intestines) and to some degree the colon.
- Plays an important role in Parathyroid Hormone synthesis which is also acted upon by Vitamin D
- Vitamin D increases Magnesium absorption
- All enzymes that metabolize Vitamin D require Magnesium
- Magnesium has a positive effect on Vitamin D deficiency.
- Magnesium and calcium are antagonist to each other on a cellular level (work against each other) They use an overlapping transport system for reabsorption within the kidneys and thereby compete with each other. Magnesium may also bind to calcium binding sites and intracellular protein binding sites due to their similarity.
- Calcium supplements can decrease Magnesium absorption.
- It Activates digestive enzymes for protein, fat and carbohydrate metabolism.
- Essential for protein synthesis
- Stores and moves energy acquired from digestion.
- Regulates Calcium via Vitamin D and increasing urinary excretion of calcium
Factors inhibiting Magnesium absorption:
- PPI
- Fiber
- Phytates
- Excessive unabsorbed fatty acids
- Calcium
- Phosphorus
- Protein
In summary, post Bariatric patients are at risk for magnesium deficiency and it plays an important role in overall health and bone health. Our practice recommends Magnesium Glycinate as the form for supplementation in at least a 2:1 ration with calcium. An example is: Calcium 2000mg daily to Magnesium Glycinate 1000mg daily. (Supplement based on your laboratory studies) We hope that this blog has answered some of your Magnesium Questions.