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Dr. Andrew Rynne
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Dr. Andrew Rynne

Family Physician

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Suggest treatment for hyperparathyroidism

Answered by
Dr.
Dr. Mirjeta Guni

Endocrinologist

Practicing since :2006

Answered : 2278 Questions

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Posted on Thu, 16 Feb 2017 in Thyroid Problem and Hormonal Problems
Question: I have high PTH levels 2 readings 116 and 106 4 months apart, but normal calcium 8.9-9.6 and Vitamin D levels (40-46). My renal function is slightly decreased with CrCl .9-1.1, EGFR 45-60
PARATHYROID HORMONE (PTH)
Past Results
Graph of Past Results
Standard Range. 14-72pg/ml
10/26/16     116. 1/18/17      106

1/18/17     
Calcium, Ionized
1.15 - 1.32 mmol/L. 1.17     
doctor
Answered by Dr. Mirjeta Guni 45 minutes later
Brief Answer:
About secondary hyperparathyroidism;

Detailed Answer:
Hello,
Thanks for the query.

From the results you reported secondary hyperparathyroidism is suspected.
Calcium is commonly low-normal or low in moderate renal failure and high PTH is a physiological response to low calcium, and to the phosphate retention that occurs in renal failure.

You checked calcium levels but not phosphates.

However, the aim is to keep PTH lower than twice normal ranges and you are at these limits.

Vitamin D derivatives (alfacalcidol, calcitriol) are used to correct hypocalcaemia resulting from reduced renal activation of vitamin D, and also have a direct suppressive effect on PTH secretion.

Often dietary advice and phosphate binders taken with food are needed to keep phosphate within acceptable limits.
So, your treating physician will advice you rather to start phosphate binders and active Vit D.

Wishing you good health.

Best wishes,
Dr.Mirjeta
Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Mirjeta Guni 13 minutes later
I did check my phosphorus and that is 2.7 -3.5 (2.3-4.5 mg/do) so they are WNL
doctor
Answered by Dr. Mirjeta Guni 4 minutes later
Brief Answer:
About high PTH;

Detailed Answer:
Welcome back,
Did you ever check PTH early in your life, before the renal function was impaired and did you check urinary calcium?

Above answer was peer-reviewed by : Dr. Yogesh D
doctor
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Follow up: Dr. Mirjeta Guni 9 hours later
11/02/2016
Urine calcium 6.3 (mg/dl)
24 hour calcium 126 mg24 hr (100-300 mg/dl)

I did not have any PTH previous readings that I am aware of.

9/16/2016
Thyroid Stimulating Hormone (TSH)     2.82 µIU/mL     0.34 - 5.66 µIU/mL
Thyroxine, Free (FT4). 2.68 ng/dL      0.52 - 1.21 ng/dl
doctor
Answered by Dr. Mirjeta Guni 3 hours later
Brief Answer:
About high PTH level:

Detailed Answer:
Hello,
At this point the only cause of raised PTH level is the impaired renal function.
There is nothing to do for the moment, just to keep the calcium, phosphates, PTH and VitD level under close monitoring.
Wish you good health!
Kind regards,
Dr.Mirjeta

Above answer was peer-reviewed by : Dr. Remy Koshy
doctor
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