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Suggest Treatment For Mildly Elevated Parathyroid Hormone
Question: Dear Doctor,
I recently went for a full check up followig heat intolerance I developed in the last two months. I am 57 year old female who is post menopausal and was getting very hot dry flushes and felt generally tired and drained. I went for a full blood test and 24 hour urine test , abdomen ultrasound, heart echo and stress test and a full hormone assay and various vitamen deficiency tests. My relsuts are as follows;
HbAic 6.2% ( normal limit is 6.0)
TRYP 2.71 ( limit is under 13.5)
Corr Calcium 2.34 mmol/L ( range is 2.15-2.55)
Thyroid Function - all normal
Complement C3 + C4- normal
Ige- normal
Cortisol- 441 nmol/L ( range 138-650)
Coeliac- normal
Iron Studies- normal
B12 Folate/RCF- normal
Vitamen D- not deficient
Kidney & Liver functions are normal.
Glucose Tolerance Test : Fasting 6.5 and 2 hours 10.8 ( diagnosed as Impaired Glucose Tolerance)
Haeoglobin- and Full blood count all within reference
CRP 1.9 ( range is 0.00-5.0)
Oestradil under 50
Progesterone under 0.5
DHEAS 4.7 umol/L ( range is 1.2 to 8.4)
Lipids and HDL- all normal
Biomarkers CEA, CA 15.3 CA 125 - all negative
ACE- normal
Androgens: Testosterone 0.7
SHBG 28
Free Androgen index- 2.5% ( all notmal)
Uriner 24 hours tests :
5HIAA, Seretonin, Catecholamine , VNA NC, Met/Normaetan , CReatenine, Albumin, protein all normal.
They also did a Para Thyroid Hormone test whisch was mildly elevated to 7 when the normal range is only up to 6.9.
My 24 hours blood pressure monitor test put in the hypertense category with lots of sipkes in my reading. Average was 154/85.
I am 55 kilos and my heightis 162 cm . My cardiologist has said that my heart is in good condition and has prescribed beta blockesr to control the pressure.
My question is about my elevated PHT levels though by blood Calcium was normal. I am osteopenic ( for the last 7 years ) and suffer from acidity and IBS and has been taking nexium 20mg for the last 6 years. I take a calcium supplement. My doctor thinks that the mildly elevated PHT may be owing to my malabsorption of calcium becuase of the nexium supplement. He thinks that my para thyroid glands shoudl not be an issue. Could there be any other resaon why my PHT is elevated. I am going to repeat the blood calcium tests and PHT in three months time . What is your recommendation. Is the PHT too high in your opinion and something to worry about. Will the recent blood pressure fluctuation and glucose intolerance be related to my PHT . Thanks.
There is a correction in my email query. The result I am worries about is PTH and should not read PHT. It is the para thyroid hormone test. Sorry for the error.
I recently went for a full check up followig heat intolerance I developed in the last two months. I am 57 year old female who is post menopausal and was getting very hot dry flushes and felt generally tired and drained. I went for a full blood test and 24 hour urine test , abdomen ultrasound, heart echo and stress test and a full hormone assay and various vitamen deficiency tests. My relsuts are as follows;
HbAic 6.2% ( normal limit is 6.0)
TRYP 2.71 ( limit is under 13.5)
Corr Calcium 2.34 mmol/L ( range is 2.15-2.55)
Thyroid Function - all normal
Complement C3 + C4- normal
Ige- normal
Cortisol- 441 nmol/L ( range 138-650)
Coeliac- normal
Iron Studies- normal
B12 Folate/RCF- normal
Vitamen D- not deficient
Kidney & Liver functions are normal.
Glucose Tolerance Test : Fasting 6.5 and 2 hours 10.8 ( diagnosed as Impaired Glucose Tolerance)
Haeoglobin- and Full blood count all within reference
CRP 1.9 ( range is 0.00-5.0)
Oestradil under 50
Progesterone under 0.5
DHEAS 4.7 umol/L ( range is 1.2 to 8.4)
Lipids and HDL- all normal
Biomarkers CEA, CA 15.3 CA 125 - all negative
ACE- normal
Androgens: Testosterone 0.7
SHBG 28
Free Androgen index- 2.5% ( all notmal)
Uriner 24 hours tests :
5HIAA, Seretonin, Catecholamine , VNA NC, Met/Normaetan , CReatenine, Albumin, protein all normal.
They also did a Para Thyroid Hormone test whisch was mildly elevated to 7 when the normal range is only up to 6.9.
My 24 hours blood pressure monitor test put in the hypertense category with lots of sipkes in my reading. Average was 154/85.
I am 55 kilos and my heightis 162 cm . My cardiologist has said that my heart is in good condition and has prescribed beta blockesr to control the pressure.
My question is about my elevated PHT levels though by blood Calcium was normal. I am osteopenic ( for the last 7 years ) and suffer from acidity and IBS and has been taking nexium 20mg for the last 6 years. I take a calcium supplement. My doctor thinks that the mildly elevated PHT may be owing to my malabsorption of calcium becuase of the nexium supplement. He thinks that my para thyroid glands shoudl not be an issue. Could there be any other resaon why my PHT is elevated. I am going to repeat the blood calcium tests and PHT in three months time . What is your recommendation. Is the PHT too high in your opinion and something to worry about. Will the recent blood pressure fluctuation and glucose intolerance be related to my PHT . Thanks.
There is a correction in my email query. The result I am worries about is PTH and should not read PHT. It is the para thyroid hormone test. Sorry for the error.
Brief Answer:
PTH
Detailed Answer:
I have perused your note in detail.
It is good that most laboratory test results that you have undergone are within normal results except
Pre diabetes (on A1c and Glucose Tolerance Test)
Mildly elevated PTH
The low female hormones reflect post menopausal status.
It looks like you are no medications except occasional Nexium. Kindly confirm this.
Moreover, I have noted your blood pressure fluctuations and the low bone density report.
When I see someone like you in my practice I proceed in the following manner, of course after a thorough physical examination (which obviously is not possible on this firm):
recheck ionized calcium ,phosphorus and intact PTH in 4 to 6 weeks in the fasting state after good hydration (ie after drinking plenty of water in preceding day).
The reason for this is that a high blood phosphorus level can raise the PTH.
Furthermore, please ensure that the PTH sample is collected with correct technique and sent off quickly to laboratory as described in the product monograph of the literature that accompanies test methods. Have the lab personnel pay attention to this important matter as it can skew the results of PTH and make it unreliable.
Vitamin D threshold for deficiency can vary from one scientific body to another. As it is well known that vitamin D deficiency can raise the PTH, I would use the higher cut off and ensure my patients vitamin D is in the 30 to 50 ng/dl range.
Lastly, there is a rare condition called 'Eucalcemic Primary Hyperparathyroidism (PHPT)' meaning the calcium levels on the blood remain normal in the beginning until PTH rises high enough to possibly culminate in a XXXXXXX PHPT picture where calcium levels eventually rise too.
PTH
Detailed Answer:
I have perused your note in detail.
It is good that most laboratory test results that you have undergone are within normal results except
Pre diabetes (on A1c and Glucose Tolerance Test)
Mildly elevated PTH
The low female hormones reflect post menopausal status.
It looks like you are no medications except occasional Nexium. Kindly confirm this.
Moreover, I have noted your blood pressure fluctuations and the low bone density report.
When I see someone like you in my practice I proceed in the following manner, of course after a thorough physical examination (which obviously is not possible on this firm):
recheck ionized calcium ,phosphorus and intact PTH in 4 to 6 weeks in the fasting state after good hydration (ie after drinking plenty of water in preceding day).
The reason for this is that a high blood phosphorus level can raise the PTH.
Furthermore, please ensure that the PTH sample is collected with correct technique and sent off quickly to laboratory as described in the product monograph of the literature that accompanies test methods. Have the lab personnel pay attention to this important matter as it can skew the results of PTH and make it unreliable.
Vitamin D threshold for deficiency can vary from one scientific body to another. As it is well known that vitamin D deficiency can raise the PTH, I would use the higher cut off and ensure my patients vitamin D is in the 30 to 50 ng/dl range.
Lastly, there is a rare condition called 'Eucalcemic Primary Hyperparathyroidism (PHPT)' meaning the calcium levels on the blood remain normal in the beginning until PTH rises high enough to possibly culminate in a XXXXXXX PHPT picture where calcium levels eventually rise too.
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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