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Parathyroid Disorders Archive Questions

Below are Dr. Streeten’s answers to Parathyroid Disorders questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 33.

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Q : 1

Could hyperparathyroidism be aggravated by taking Synthroid? I was diagnosed with mild hypothyroidism several years ago. We raised my dosage a couple years after that because I was still experiencing symptoms that now seem more likely to have been hypoparathyroidism (I'm waiting on PTH results, but I've had a high blood calcium result in the past and three extremely low Vitamin D results despite prescription-level supplements). After the increased Synthroid I experienced debilitating symptoms including brain fog, muscle aches, feeling very cold, elevated heart rate, fatigue etc that did not go away when the dosage was lowered back. Does this make sense as a possible interaction or is there more likely to be something else at play?

Hypothyroidism and primary hyperparathyroidism are totally separate problems and do not generally influence each other.

Q : 2

There is a genetic condition known as PXE in my family. Do you know if this metabolic disorder is related to parathyroid problems?

I am not aware of any association between pseudoxanthoma elasticum and parathyroid problems. However, there may be an association with kidney stones and elevated 1,25-D, the active form of vitamin D. I hope this helps.

Q : 3

I have low vitamin D and a nodule, is it possible to have hyperparathyroidism and a normal calcium level?

You didn't mention what your blood PTH level is. The type of hyperparathyroidism (HPT), primary versus secondary, is determined by the blood calcium. If the blood calcium is normal, almost always, it is secondary HPT (e.g. usually due either to vitamin D deficiency or excessive urine loss of calcium), whether or not any enlarged parathyroids are seen with imaging. In secondary HPT, the parathyroid glands are appropriately responding to another problem (most commonly vitamin D deficiency) and since they enlarge with secondary HPT, a "nodule" may be seen on ultrasound, but that doesn't mean it needs to be removed. Primary HPT almost always is associated with an elevated blood calcium. It is possible to have primary HPT with a normal blood calcium but this cannot be determined until after a thorough evaluation (eg. measuring the level of active vitamin D, [1,25(OH)2D] and giving a 1-2 week course of calcitriol to determine if the PTH suppresses and calcium remains normal).

Q : 4

Is there a drug-free way to treat hyperprolactinemia caused by a 6 mm tumor on the pituitary gland? The only symptom is amenorrhea.

The only other treatment for a microprolactinoma (tumor <10 mm) is surgical removal. This is is generally not done because a twice a week medication (cabergoline) does a great job of controlling it.

Q : 5

My sister had an MRI and the results said, "suggestive of right sided parathyroid adenoma." Is there a medication she can take for this or will she have to have surgery?

The localization of a parathyroid gland on a MRI does not answer the question of whether it needs to be surgically removed or not. That answer can only come from your sister's treating physician who knows your sister's complete history including how high her calcium is and what her symptoms are. When the decision is made that a patient needs treatment for primary hyperparathyroidism, surgical removal is the treatment. In some cases, when patients are not good surgical candidates, medical management with cinecalcet (Sensipar) is an alternative.

Q : 6

I have PTH 90, calcium serum 9.6 (usually 9.0-9.1), and vitamin D 11.0. My endocrinologist saw two parathyroid tumors on an ultrasound, but now says I have secondary and not primary. How can this be when my calcium level is not low and I do not have kidney disease? I also have osteopenia.

Secondary hyperparathyroidism (HPT) is diagnosed when the blood calcium is normal and PTH is elevated. In secondary HPT, the parathyroid glands are simply reacting to something else, trying to compensate. The most common cause of secondary HPT is vitamin D deficiency, as seen in you. Other causes of secondary HPT are excessive loss of calcium through the urine, and age-related reduction in activation of the storage form of vitamin D (25-D) to the active form (1,25-D). Generally with secondary hyperparathyroidism, the blood calcium is normal not low. Since all 4 parathyroid glands are generally overworking in secondary HPT, it is not uncommon to find that they are enlarged if imaging is (inappropriately) done. Removing the parathyroid glands in secondary HPT is generally not appropriate.

Q : 7

When does a patient have mild parathyroidism? My blood calcium level has been elevated since August of 2008 and ranged from 10 to 11.1. My most recent level was 10.5. When is it time for surgical removal of the gland? I do have a positive scan which shows an adenoma of one of the four glands.

You are referring to primary hyperparathyroidism. For patients who have no symptoms (no history of kidney stones or reduced kidney function, no osteoporosis or fracture history, no achiness of muscles or joints), conservative monitoring is often a reasonable approach. The best person to recommend what you should do is your endocrinologist, who knows all your history. If you are not seeing an endocrinologist, I recommend that you do.

Q : 8

I have hypoparathyroidism due to a TT surgery in 2009. My phosphorous levels run about 15-20 percent above normal. How long they can do this before I have to be worried about long-term damage? Is there a safe, slightly elevated level I can live with? When is medication necessary?

Hypoparathyroidism is generally associated with an elevated blood phosphorus (P) because parathyroid hormone (PTH) is missing and one of the jobs of PTH is to stimulate P excretion in the urine. PTH (injected twice a day) is being studied as a possible treatment for hypoparathyroidism, which normalizes the blood P, but it is not approved or on the market yet. If the P gets too high, P binders can be used (generally only used in patients with high P related to chronic kidney disease), but generally these are not necessary.

Q : 9

My 16-year-old daughter was born with no thyroid. Does that mean it's possible that she has no parathyroid glands either?

Interesting question, but the answer is no. If she had no parathyroids, you would know it by now because she would have had severely low blood calcium as an infant.

Q : 10

Is there a way to detect if the parathyroid is tumorous through radiology?

The Sestamibi parathyroid scans detects about 75 percent of enlarged parathyroids and the parathyroid ultrasound detects them in 50-75 percent of cases, depending on the person who is doing the ultrasound. These are not tests to diagnose an overactive parathyroid- that is done by blood tests. However, both are useful tests to do in a person with primary hyperparathyroidism (elevated calcium and parathyroid hormone) who needs surgery, to determine if the person is a candidate for minimally invasive surgery.

Q : 11

My 32-year-old daughter has a parathyroid adenoma. All her blood levels are normal so they are just monitoring her condition. She has muscle pain, nausea and keeps gaining weight. Is there anything she can take to ease the symptoms?

A correct diagnosis of primary hyperparathyroidism almost always is associated with an elevated blood calcium level. I would wonder if her muscle pain and nausea have another cause. Weight gain does not come from parathyroid problems. I recommend that she ask her endocrinologist about treatment.

Q : 12

I am in stage 2, almost 3, of renal failure and only have one kidney. Last year i was diagnosed with hypoparathyroidism and hypocalcemia. I am having to take about 14 mg of calcium (citrate) and 50 units of vitamin D daily, which I have learned is damaging my already damaged kidney. I am also having daily headaches, kidney and gallstones, and pain and sensitivity to pressure in the general area. Are there any other ways to get calcium without damaging my kidney?

Calcium and vitamin D do not generally damage the kidneys. I recommend that you either see your endocrinologist again or find another endocrinologist who will explain your situation to you. In general, the most common cause of hypoparathyroidism (underactivity of the parathyroid glands), besides surgical removal of them (such as in thyroidectomy), is autoimmune. In autoimmune hypoparathyroidism, the body produces an antibody that causes the parathyroid glands to stop working. In hypoparathyroidism, prescription vitamin D is the treatment.

Q : 13

Four years ago, I had my thyroid removed because of papillary cancer. I have gained 20 pounds that I can't seem to lose and now I'm at risk for diabetes. Do you have any suggestions?

Thyroid hormone does not cause weight gain so that's not the cause. There is no "magic bullet" for losing weight. Reducing calories taken in and increasing calories expended by exercise is the way to lose.

Q : 14

An ultrasound and Sestamibi showed an enlarged parathyroid gland at 1.8 cm on the lower right side. I want to wait to have surgery, am I at a greater risk? I'm currently not experiencing any symptoms.

After a parathyroid adenoma is localized by both US and Sestamibi to the same area, it can be removed by outpatient, minimally invasive surgery. It is best to have the procedure performed by a surgeon who does a lot of them. Risks of waiting to have surgery are kidney stones, osteoporosis, stomach ulcers, generally not feeling well, achiness and depression. It's a good idea to prevent symptoms rather than wait for them to occur.

Q : 15

My calcium has been as high as 10.5 and fluctuates often. My PTH is 22. Could I still have hyperparathyroidism? I heard that PTH being normal does not matter.

In all non-parathyroid causes of elevated blood calcium, the PTH is suppressed (below the normal range, eg. under 15). Assuming a normal vitamin D level (25(OH)D) and blood albumin level, an elevated calcium is generally indicative of mild primary hyperparathyroidism.

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