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Dr. Andrew Rynne

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Diagnosed with vitamin D deficiency and high PTH. Is this the cause for concern?

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Dr. Michelle Gibson James

General & Family Physician

Practicing since :2001

Answered : 15828 Questions

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Posted on Fri, 22 Nov 2013 in Thyroid Problem and Hormonal Problems
Question: Hi, I was diagnosed with low vit D , normal calcium and high PTH. My vit D is back to 50 after taking 2000iu daily of vit D but my PTH went from 93 to 103. Normal calcium.
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Answered by Dr. Michelle Gibson James 46 minutes later
Brief Answer: Parathyroid was high to make up for low vitamin D Detailed Answer: Hi, thanks for using healthcare magic Both vitamin D and the parathyroid hormone are involved in maintaining normal levels of calcium. These two substances act to increase the levels of calcium. Because your level of vitamin d were low, it would not have been able to act effectively to help the parathyroid hormone to maintain its normal levels. This means the level of parathyroid hormone would have needed to increase (to compensate for the low vitamin D) to keep the calcium within normal range. Now that your levels of vitamin D are returning to normal due to replacement therapy, the parathyroid levels can decrease because vitamin d is now around to help with the calcium levels. I hope this helps, feel free to ask any other questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Michelle Gibson James 5 minutes later
But the problem is that the PTH have increased from 93 to 103. My vit d increased from 20 to 50, but parathyroid increased instead of decreasing. Once the hormone is elevated, how long does it take to go back to normal. I also have kidney and gallstones
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Answered by Dr. Michelle Gibson James 41 minutes later
Brief Answer: the total calcium may be normal but the free low Detailed Answer: Hi I apologise for the above, the parathyroid will eventually decrease as your blood values normalise. To explain the increase we will have to explore how the parathyroid hormone is stimulated. As mentioned above both vitamin d and parathyroid play a part in maintaining normal levels of calcium but the vitamin d response is slower than the response of the parathyroid hormone. Calcium is found in different formats in the body, a lot of it is in the bone. The calcium that is not in the bone is either attached to protein in the blood or free (not attached to anything). It is the free calcium that is active in the body and it is the free calcium that stimulates the parathyroid gland to let out the parathyroid hormone. Blood tests can measure both the total calcium or the free calcium but it is the free that is important. The total calcium can be normal but only a small amount of it is free because a lot of it is attached to protein. The parathyroid gland is stimulated to release or make more parathyroid hormone only on the basis of the level of the free calcium. When this free calcium level is normal , a message is sent to the parathyroid gland that prohibits it to make more hormone. This is called negative feedback. The parathyroid gland would not release any more of its hormone if the level of FREE calcium is normal. You can confirm this with your doctor or any practitioner. The fact that it is going up implies that though your total calcium is normal , your free calcium is low and this low free calcium is causing the parathyroid hormone levels to increase. Low free calcium occurs in two main instances: (1) if the level of protein in the system is high and as a result attaching a lot of the calcium. The protein levels can be checked. (2)if there is alkalosis. This means the ph of the blood is higher than normal so there is an alkaline state. When alkalosis occurs , calcium becomes more attracted to the protein and there is also a decrease in free calcium You need additional blood tests. Your doctor may consider checking your protein levels and also checking your acid/alkaline status. I hope this is clear Please feel free to ask any additional questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Michelle Gibson James 44 minutes later
I have had ionized calcium a couple of times and was told it was fine. However , I have not received my recent report, I see my Dr. On Friday. Would the fact that I had a hysterectomy at age 38 cause any of this. I still have my ovaries. Would this cause my gallstones and kidney stones. I am hoping it's still due to low vit d, which was what my Dr. Was leaning towards at my last appt. I was worried about hyperparathyroidism.
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Answered by Dr. Michelle Gibson James 1 hour later
Brief Answer: the uterus does not play a role in these hormones Detailed Answer: HI The uterus is not involved in calcium levels or the production of parathyroid hormone or influence vitamin D levels so the hysterectomy would not affect or cause your present problem. The main areas of the body involved are the parathyroid gland and the kidneys (this is the reason persons with kidney failure have low vitamin D and increased parathyroid). There are different types of kidney stones, the most common are composed of calcium. This is less likely with low calcium levels. High parathyroid hormone levels however, with increased calcium can cause both kidney and gallstones but your calcium is not elevated. Increased parathyroid hormone can be primary (related to the gland itself) or secondary (due to a low calcium). In your case, with the history of low vitamin d, it is more likely secondary and should resolve once all the factors are corrected. The results of your last blood tests show clarify the problem Please feel free to ask any additional questions
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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