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Suggest Remedy For Parathyroid Disease

Posted on Thu, 12 Nov 2015

Question: My endocrologist says I am a textbook case of parathyroid disease except my pth is not high. He said there were explanations for that. What could they be?

Answered by Dr. Shehzad Topiwala (3 hours later)

Brief Answer:
Parathyroid

Detailed Answer:
When blood calcium levels are high, the PTH ought to be low. If it is not, it is abnormal. Even normal PTH levels in the presence of high blood calcium levels are considered inappropriate.

Calcium , PTH, Phosphorus and Vitamin D are complex tests related to parathyroid disease.

There is a rare condition called FHH which stands for Familial Hypocalciuric Hypercalcemia. In this inherited disorder, the kidneys are unable to excrete calcium in the urine and so it tends to accumulate in the blood in mildly high levels. It is important to diagnose this correctly because it does not need any treatment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (55 minutes later)

Vitamin d is low. Was started on 3000 mg a day a year ago when vitamin d was 11.6 and now it's 22.3. Endo took me off of vitamin d because it was making calcium go up. I have 3 or 4 bouts of kidney stones a year. Pth is 20' calcium 11.1 . Calcium oxlate stones.

Answered by Dr. Shehzad Topiwala (20 hours later)

Brief Answer:
Follow up

Detailed Answer:
You are correct in surmising the unlikelihood of FHH in light of the urine calcium result.

Urine calcium is best interpreted along with Urine creatinine measurements.

Your PTH is on the cusp of what is considered typical for a diagnosis of Primary Hyperparathyroidism.

Stay i touch with your endocrinologist and plan the next step carefully. Sestamibi scans are performed sometimes in evaluation of this condition.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (59 minutes later)

I have had a sestambia scan but have gotten results yet. Endo said they were accurate in finding adeoma said because of the size of them. Other than hypo or cancer what would cause high calcium low vitamin d

Answered by Dr. Shehzad Topiwala (32 hours later)

Brief Answer:
Second follow up

Detailed Answer:
There is no' hypo' here. It is hypercalcemia i.e. high calcium, likely du to hyperparathyroidism i.e. an over active parathyroid gland.
Sestamibi does not always localise it.

The only hypo here is 'hypoVitaminosis D' i.e. low vitamin D, which can raise the PTH and consequently the calcium but your PTH is not that high.

High dietary intake of calcium can also do this.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (1 hour later)

If sestambia scan doesn't localize it then how can you find out for sure. What treatments are available for hyperparathyroidism? I don't eat a lot of foods with calcium and don,t drink milk or eat cheese. I stopped those when I started having calcium stones.

Answered by Dr. Shehzad Topiwala (4 hours later)

Brief Answer:
Third follow up

Detailed Answer:
1 There is no 100% sure test to localise the adenoma

Most often when the PTH is above 20 in the face of high blood calcium , it is almost certain there is 'Hyperparathyroidism' provided there are no medications like

Thiazide diuretics or Lithium

on board.

2 Treatment is typically Surgical removal of the overactive parathyroid gland(s). A medication called Cinacalcet is an option too

3 Completely avoiding calcium in the presence of calcium containing kidney stones may seem logical but scientifically it is quite the opposite. One is encouraged to consume adequate calcium because it binds oxalate in the gut and reduces the chance of calcium oxalate stones.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (19 hours later)

What does vitamin d have to do with parathyroid. Mine was 11.6 and the doctor put me on 3000 mg a day of d3 after a year it was 22.3 and calcium had went from 10.0 then 10.8 and now 11.2. Doctor said stop taking vitamin d that it was body trying to protect against high calcium. He said pth was puzzling since it hasn't tested high . I have a bone density scheduled . What does that have to do with parathyroid ? Parathyroid seems to be a rare problem and hard to diagnose.

Answered by Dr. Shehzad Topiwala (51 minutes later)

Brief Answer:
Fourth follow up

Detailed Answer:
1 Vitamin D and parathyroid are very closely linked , as is the calcium

2 You probably mean 3000 IU (International Units) and not mg of Vitamin D3

3 PTH does not have to be high to diagnose 'Primary Hyperparathyroidism' (1HPT)

If it is NOT LOW, that is inappropriate and sufficient to make a diagnosis of 1HPT

4 Bone density can go down in untreated cases of 1HPT

5 Parathyroid is not very challenging for most endocrinologists as they deal with it fairly frequently and are specially trained in managing it

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (1 hour later)

Could parathyroid be an inherited disease? Sorry I am asking you so many questions. You explain things better than most doctors. I haven't had good luck with doctors in most cases. I am from a small town and medical care here is not the best. I don't think they are bad doctors by no means but have never seen many cases. I kinda noticed my calcium was way too high and started getting results from different doctors and looked it up on the Internet. A few months later an endo from a town 2 hours away sent me a message from a mutual friend he could figure out what was going on. I made an appointment with him and on second visit he said he was 90 percent sure I had a parathyroid problem. But before he will send me to XXXXXXX parathyroid clinic I have to have lots of test , as he says I want to be sure before you have surgery. I respect him for wanting to make sure but 8 or 9 years of this is frustrating. I can't remember the last time I felt good. Sometimes when I walk it fells like my bones are going to break. i am very off balance. Somehow I am managed to work through all this ( and actually still rated number 1 in 3 states in my profession) . Can't figure that one out. But putting all that aside I have 4 grandchildren and the best part of off time I enjoy being with them and it seems lately I don't have the energy for it. It sounds like it will be the first of next year before he is done sending me for test. I guess my question is should I just go to XXXXXXX parathyroid clinic and go ahead with surgery without his referral?

Answered by Dr. Shehzad Topiwala (12 hours later)

Brief Answer:
Fifth follow up

Detailed Answer:
Surgery is an option. But please undergo a systematic evaluation which entails in-person visits with a qualified endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (34 hours later)

Oh I am seeing an endocrinologist just seems like it's taking forever. Lots of test before he will refer me for surgery. What test should be preformed prior to surgery. I have had a sestambia scan. Haven't been for follow up for the results but the nurse told me it was normal. What other test should be preformed?

Answered by Dr. Shehzad Topiwala (7 hours later)

Brief Answer:
Sixth follow up

Detailed Answer:
At the moment, no further tests need to be done. Just follow your endocrinologists guidance. Sometimes an Ultrasound examination reveals an adenoma in the neck area where the parathyroid glands are located. But it is unto the discretion of the treating doctor whether to order one or not

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Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar