Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Causes Elevated PTH Levels?
Question: I have been diagnosed with hyperparathyroidism. My calcium # areTable
Component Standard Range 5/31/2013 11/12/2013 1/16/2014 5/1/2014 6/1/2014
Calcium 8.5-10.2 mg/dL 10.3 9.7 10.0 10.0 10.4
Vitamin D was 14 but with 50,000 + 6000 daily is now 29
My Intact PTH is Intact PTH 134.1 15.0 - 65.0 pg/mL I have been told to waith until my calcium level is 11 > by my Internist and then I will be referred to an Endocrinologist Surgeon. He told me not to be in a hurry due to risk to the vocal cords. To date I only have these test results to go on. You opinion would be greatly appreciated.
Component Standard Range 5/31/2013 11/12/2013 1/16/2014 5/1/2014 6/1/2014
Calcium 8.5-10.2 mg/dL 10.3 9.7 10.0 10.0 10.4
Vitamin D was 14 but with 50,000 + 6000 daily is now 29
My Intact PTH is Intact PTH 134.1 15.0 - 65.0 pg/mL I have been told to waith until my calcium level is 11 > by my Internist and then I will be referred to an Endocrinologist Surgeon. He told me not to be in a hurry due to risk to the vocal cords. To date I only have these test results to go on. You opinion would be greatly appreciated.
Brief Answer:
Hello. Some more details needed
Detailed Answer:
Hello,
Good day.
Your calcium levels are not that high ( except one value) even though the PTH level is elevated. There are number of reasons for PTH elevation.
1) Primary Hyperparathyroidism ( problem with gland itself)
2) Secondary Hyperparathyroidism ( due to low vitamin D or due to kidney problems)
3) Tertiary Hyperparathyroidism.
Kidney problems, Vitamin D deficiency, Calcium deficiency etc can cause PTH levels to go high which is called as Secondary Hyperparathyroidism. This is very common. Surgery is not required for this and vitamin D replacement improves PTH levels.
In Primary and tertiary hyperparathyroidism, you may need surgery.
HAve you had kidney function tests, Serum Phosphorus ( fasting) and Alkaline phosphatase, Urine calcium, Bone density scan ( DXA scan), Xray of bones etc??
Di you have an ultrasound scan of neck or SESTAMIBI scan?
We look at few of the above tests to determine the cause of PTH elevation ( Primary/Secondary/Tertiary) .
I would appreciate if you could write to me if any of the above test results are available.
Regards
Binu
Hello. Some more details needed
Detailed Answer:
Hello,
Good day.
Your calcium levels are not that high ( except one value) even though the PTH level is elevated. There are number of reasons for PTH elevation.
1) Primary Hyperparathyroidism ( problem with gland itself)
2) Secondary Hyperparathyroidism ( due to low vitamin D or due to kidney problems)
3) Tertiary Hyperparathyroidism.
Kidney problems, Vitamin D deficiency, Calcium deficiency etc can cause PTH levels to go high which is called as Secondary Hyperparathyroidism. This is very common. Surgery is not required for this and vitamin D replacement improves PTH levels.
In Primary and tertiary hyperparathyroidism, you may need surgery.
HAve you had kidney function tests, Serum Phosphorus ( fasting) and Alkaline phosphatase, Urine calcium, Bone density scan ( DXA scan), Xray of bones etc??
Di you have an ultrasound scan of neck or SESTAMIBI scan?
We look at few of the above tests to determine the cause of PTH elevation ( Primary/Secondary/Tertiary) .
I would appreciate if you could write to me if any of the above test results are available.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
No other test available. This is one of the reason I wanted to get a your opinion. Should I take it upon myself to insist on more testing or take a wait and see approach waiting to see if the calcium continues to rise? I don't want to act prematurely but on the other hand I want to be
proactive in my own care. Thank you in advance.
proactive in my own care. Thank you in advance.
Brief Answer:
Hello
Detailed Answer:
Hi,
Yes, we need some more tests to pinpoint the diagnosis. Just doing calcium and PTH is not enough. Since your Vitamin D levels are better now, better to get a repeat PTH levels done to see if it is improving.
Below are the tests which I would suggest,
1) Serum PTH ( to be collected and transported to lab in a cooled syringe and then transport wrapped in ice packs)
2) Fasting serum calcium, serum albumin, Serum Phosphorus, Serum alkaline phosphatase.
3) 24 hour Urine calcium to creatinine ratio
4) Serum creatinine, Urea and GFR
THESE ARE THE BASIC TESTS. BASED ON THESE, WE CAN DECIDE IF YOU REQUIRE ANY OTHER TESTS LIKE SCANS and Xrays etc.
Regards
Binu
Hello
Detailed Answer:
Hi,
Yes, we need some more tests to pinpoint the diagnosis. Just doing calcium and PTH is not enough. Since your Vitamin D levels are better now, better to get a repeat PTH levels done to see if it is improving.
Below are the tests which I would suggest,
1) Serum PTH ( to be collected and transported to lab in a cooled syringe and then transport wrapped in ice packs)
2) Fasting serum calcium, serum albumin, Serum Phosphorus, Serum alkaline phosphatase.
3) 24 hour Urine calcium to creatinine ratio
4) Serum creatinine, Urea and GFR
THESE ARE THE BASIC TESTS. BASED ON THESE, WE CAN DECIDE IF YOU REQUIRE ANY OTHER TESTS LIKE SCANS and Xrays etc.
Regards
Binu
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Thanks so much
Brief Answer:
hi
Detailed Answer:
No worries. Please let me know the reports.
Have a great weekend
regards
Binu
hi
Detailed Answer:
No worries. Please let me know the reports.
Have a great weekend
regards
Binu
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
Get personalised answers from verified doctor in minutes across 80+ specialties
