1. < Diabetes & Endocrine System

Parathyroid hormone: I'm considering my treatment options

Posted by tsch @tsch, May 6, 2022

Read through most of the comments about hyperparathyroidism, but did not see any situations like mine: I have absolutely no negative symptoms or pains, but last blood test showed PTH of 174. I have known it to be elevated since January 2020. Endocrinologist plan is to monitor as I have had all diagnostic tests and all are normal. Wondering if I should think more about surgery since there is clearly a problem with at least one parathyroid gland.

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plstroud | @plstroud | May 7, 2022
In reply to @tsch "Your situation is quite a bit like mine. My vitamin D was on the low side..." + (show)
@tsch

Your situation is quite a bit like mine. My vitamin D was on the low side (27-30) but now is about 50, after taking supplement. I have had PTH tested about 6-7 times since 1/2020, and its been elevated all the time. I think 174 (1/2022) is the highest yet, and its never been normal since 1/2020. My 2 year bone density will be in November. I do have for a many years ostopenia in one femur head. I suspect my PTH levels will never be normal, and wonder if its better to do surgery now or wait and hope it is never needed. I have had two ultrasounds to look for parathyroid glands and they could not be seen. Reluctant to do a nuclear (possibly more definitive) scan as I would have to stop Synthroid and I do not want to do that unless absolutely necessary. Good luck to you. I am female and 79 (ugh) and otherwise in excellent health. Would you mind telling your sex and age?

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I am a male about to turn 66 next month. I am trying to get any medical issues resolved before I retire at the end of this year. I figure it would be best to go into retirement with as few medical issues as possible.

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Mentor
Teresa, Volunteer Mentor | @hopeful33250 | May 8, 2022
In reply to @plstroud "The weird twist to this is that my PCP deferred to the endocrinologist's determination and she..." + (show)
@plstroud

The weird twist to this is that my PCP deferred to the endocrinologist's determination and she had not checked them again until just this February. I think she was surprised that they weren't in the normal range. She had checked my calcium, potassium, etc. on a yearly basis as part of normal checkups (basic metabolic panel) and since they were normal she didn't do the extra PTH test. I guess a lot of doctors would make the assumption that if the calcium level is normal, no need for the extra PTH test.

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@plstroud,

I had a similar situation. During my annual physicals, my calcium levels were only slightly elevated, not enough to indicate the possibility of hyperparathyroidism. After several years of my PCP telling me that the slight elevation in the calcium level was probably the result of having my blood drawn when fasting and that the elevated levels were probably a result of dehydration, I decided to drink 16 oz. of water before my next series of blood draws was done. When the calcium level was still somewhat high, I told my PCP that it probably wasn't a result of dehydration and she then checked the PTH level and found it to be 145.

From there, I went to an endocrinologist. It is good to keep advocating for yourself.

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1 reply
bonaroo | @bonaroo | Jun 10, 2022
In reply to @hopeful33250 "@plstroud, I had a similar situation. During my annual physicals, my calcium levels were only slightly..." + (show)
@hopeful33250

@plstroud,

I had a similar situation. During my annual physicals, my calcium levels were only slightly elevated, not enough to indicate the possibility of hyperparathyroidism. After several years of my PCP telling me that the slight elevation in the calcium level was probably the result of having my blood drawn when fasting and that the elevated levels were probably a result of dehydration, I decided to drink 16 oz. of water before my next series of blood draws was done. When the calcium level was still somewhat high, I told my PCP that it probably wasn't a result of dehydration and she then checked the PTH level and found it to be 145.

From there, I went to an endocrinologist. It is good to keep advocating for yourself.

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I’m wondering what Mayo considers a “high calcium”. I’ve found articles from University of Madison ( for one) where a calcium of 10.3 is high. My calcium’s have been anywhere from 10.7 - 10.2 for the past two years. I didn’t think much of it until it was over the 10.5 range since that is considered over at my place of care. So it was rechecked & slightly lower at 10.4.
When I inquired what would cause this I was told “many things” “dehydration” etc.
I’m NOT dehydrated. I don’t have kidney issues or cancer which cause high calcium.
Vit d = normal. PTH was 38 & 77.8 ( only times it was checked)
I’m just really starting to think Dr’s really don’t know much about this. I already see endocrinology for my THYROID.
Anyway I have brain fog, constipation, feel super oddly fatigued, weakish arms, poor sleep & im 52.
I’ve read most adults sit consistently in the 9’s.
I don’t like the watch & wait method or am I misinformed?
What does Mayo do? I have requested an appt there & im hoping they are more proactive cuz if they aren’t I don’t want to travel & pay out of network.
What are their “normal calcium” & PTH guidelines.

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2 replies
bonaroo | @bonaroo | Jun 10, 2022
In reply to @bonaroo "I’m wondering what Mayo considers a “high calcium”. I’ve found articles from University of Madison (..." + (show)
@bonaroo

I’m wondering what Mayo considers a “high calcium”. I’ve found articles from University of Madison ( for one) where a calcium of 10.3 is high. My calcium’s have been anywhere from 10.7 - 10.2 for the past two years. I didn’t think much of it until it was over the 10.5 range since that is considered over at my place of care. So it was rechecked & slightly lower at 10.4.
When I inquired what would cause this I was told “many things” “dehydration” etc.
I’m NOT dehydrated. I don’t have kidney issues or cancer which cause high calcium.
Vit d = normal. PTH was 38 & 77.8 ( only times it was checked)
I’m just really starting to think Dr’s really don’t know much about this. I already see endocrinology for my THYROID.
Anyway I have brain fog, constipation, feel super oddly fatigued, weakish arms, poor sleep & im 52.
I’ve read most adults sit consistently in the 9’s.
I don’t like the watch & wait method or am I misinformed?
What does Mayo do? I have requested an appt there & im hoping they are more proactive cuz if they aren’t I don’t want to travel & pay out of network.
What are their “normal calcium” & PTH guidelines.

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University of Madison also has many good videos on their site regarding calcium & PTH. Their information states if calcium is even higher at 10.3 ( let’s say) the PTH should be more like 15..or very low.
My primary told me today calcium fluctuates widely & who knows maybe you drank a glass of milk before your lab draw.
What I have read & researched is that it’s a very precise mechanism in the body…it shouldn’t “fluctuate” & 10’s are too high for an adult.
???

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1 reply
Moderator
Colleen Young, Connect Director | @colleenyoung | Jun 10, 2022
In reply to @bonaroo "I’m wondering what Mayo considers a “high calcium”. I’ve found articles from University of Madison (..." + (show)
@bonaroo

I’m wondering what Mayo considers a “high calcium”. I’ve found articles from University of Madison ( for one) where a calcium of 10.3 is high. My calcium’s have been anywhere from 10.7 - 10.2 for the past two years. I didn’t think much of it until it was over the 10.5 range since that is considered over at my place of care. So it was rechecked & slightly lower at 10.4.
When I inquired what would cause this I was told “many things” “dehydration” etc.
I’m NOT dehydrated. I don’t have kidney issues or cancer which cause high calcium.
Vit d = normal. PTH was 38 & 77.8 ( only times it was checked)
I’m just really starting to think Dr’s really don’t know much about this. I already see endocrinology for my THYROID.
Anyway I have brain fog, constipation, feel super oddly fatigued, weakish arms, poor sleep & im 52.
I’ve read most adults sit consistently in the 9’s.
I don’t like the watch & wait method or am I misinformed?
What does Mayo do? I have requested an appt there & im hoping they are more proactive cuz if they aren’t I don’t want to travel & pay out of network.
What are their “normal calcium” & PTH guidelines.

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@bonaroo, you ask "What does Mayo do?" is a great question. Answers to that question are based on you and your condition, test results etc. I see that you've requested an appointment. When you discuss with the scheduler, you will have the opportunity to ask the questions you are asking here, such as the approach, treatment vs. watch and wait, and if your local care aligns with their recommendations. Mayo's physician expert review of your request and medical records will determine whether Mayo Clinic could offer any further or different treatment for you. It is our goal to provide the best care each patient needs, however we do not want to have you incur additional costs for evaluation or travel if we do not feel we can offer care that is different from what you’re already receiving.

Here's more information about calcium testing and hypercalcemia from Mayo Clinic Laboratories. https://www.mayocliniclabs.com/test-catalog/Overview/601514#Clinical-and-Interpretive
"The level at which hypercalcemic symptoms occur varies from patient to patient. Symptoms are common when serum calcium levels are above 11.5 mg/dL, although patients may be asymptomatic at this level. Levels above 12.0 mg/dL are considered a critical value. Severe hypercalcemia (>15.0 mg/dL) is a medical emergency."

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Mentor
Teresa, Volunteer Mentor | @hopeful33250 | Jun 10, 2022
In reply to @bonaroo "University of Madison also has many good videos on their site regarding calcium & PTH. Their..." + (show)
@bonaroo

University of Madison also has many good videos on their site regarding calcium & PTH. Their information states if calcium is even higher at 10.3 ( let’s say) the PTH should be more like 15..or very low.
My primary told me today calcium fluctuates widely & who knows maybe you drank a glass of milk before your lab draw.
What I have read & researched is that it’s a very precise mechanism in the body…it shouldn’t “fluctuate” & 10’s are too high for an adult.
???

Jump to this post

Hello @bonaroo

In addition to the information that Colleen, @colleenyoung, provided to you. Here is a link from Mayo Clinic's website that describes some of the symptoms of hyperparathyroidism. https://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/symptoms-causes/syc-20356194.

Have you had any kidney stones or are you experiencing any bone loss ( such as osteoporosis or osteopenia)?

REPLY
1 reply
soulsign | @soulsign | Jul 3, 2022
In reply to @hopeful33250 "Hello @bonaroo In addition to the information that Colleen, @colleenyoung, provided to you. Here is a..." + (show)
@hopeful33250

Hello @bonaroo

In addition to the information that Colleen, @colleenyoung, provided to you. Here is a link from Mayo Clinic's website that describes some of the symptoms of hyperparathyroidism. https://www.mayoclinic.org/diseases-conditions/hyperparathyroidism/symptoms-causes/syc-20356194.

Have you had any kidney stones or are you experiencing any bone loss ( such as osteoporosis or osteopenia)?

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Yes osteoporosis

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1 reply
Mentor
Teresa, Volunteer Mentor | @hopeful33250 | Jul 3, 2022
In reply to @soulsign "Yes osteoporosis" + (show)
@soulsign

Yes osteoporosis

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Hello @soulsign and welcome to Mayo Connect. I appreciate your post in this discussion on hyperparathyroidism. From your comment, it appears that you have osteoporosis. Is that correct?

If you would like to share more, I'm wondering how long ago you were diagnosed. Also, do you have hyperparathyroidism? If so, how was that diagnosed?

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soulsign | @soulsign | Jul 5, 2022

I’ve had osteoporosis for a while and now have a parathyroid adenoma. Started prolia and md says not a great candidate for surgery. Have seen surgery done under twilight sedation.

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2 replies
Mentor
Teresa, Volunteer Mentor | @hopeful33250 | Jul 6, 2022
In reply to @soulsign "I’ve had osteoporosis for a while and now have a parathyroid adenoma. Started prolia and md..." + (show)
@soulsign

I’ve had osteoporosis for a while and now have a parathyroid adenoma. Started prolia and md says not a great candidate for surgery. Have seen surgery done under twilight sedation.

Jump to this post

Hello @soulsign

I'm sorry to hear that you are not considered a good candidate for parathyroid surgery. I have that problem as well. I have a paralyzed vocal cord and the risk of causing a problem to the other vocal cord makes it a more tenuous procedure.

Have you contacted a large medical facility to see if they have the medical staff to perform the surgery? I'm thinking of a university medical school or a facility like Mayo Clinic.

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