Here’s Why It’s Important To Get Diagnosed For High Levels Of Pth
Written by Bhavyajyoti Chilukoti | Published : July 12, 2017 3:42 PM IST
Unlike thyroid disease, problems with the parathyroid gland are not known. The gland secretes parathyroid hormone , which plays a key role in maintaining your calcium balance in the body. Dr Ritesh Agarwal, Thyroid, Endocrine, Breast & Cancer Surgeon at SL Raheja Hospital, Mumbai sheds light on what can happen during hyperparathyroidism and what is the treatment option available to deal with it.
What happens if you have high PTH levels?
As calcium is stored in the bones, the major function of the PTH hormone is to dissolve the bones and release calcium from the bones. When PTH functions normally the calcium balance is maintained easily. However, if there is an excess of PTH, excess calcium is released from the bones, which can lead to a weakening of the bones. This, in the long run, can cause osteoporosis and other orthopaedic problems. Read about signs that indicate your body lacks calcium.
Does Pth Break Down Bone
PTH is a hormone produced by the parathyroid glands there are four parathyroid glands, and together, they help regulate calcium levels in the body. PTH increases calcium in several ways it breaks down bone, improves the bodys ability to obtain calcium from food, and increases the kidneys ability to contain calcium.
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Is A Phosphorus Test Necessary
Research indicates that phosphorus stimulates PTH secretion and synthesis. However, dietary phosphorous sometimes increases the bodys production of calcitriol, a synthetic version of vitamin D3 that is commonly used to treat a calcium deficiency. When this happens, phosphorous can disrupt the bodys calcium levels.
A phosphorous test allows a doctor to measure the amount of phosphate in a patients blood. It is performed via a blood draw from a patients vein the blood is generally drawn from inside of a patients elbow or the back of his or her hand.
A doctor may recommend that a patient stop taking certain medications leading up to a phosphorous test. Upon completion, the test allows a doctor to see if a patients phosphorous levels fall within a normal range of 2.4 to 4.1 mg/dl.
If a patient is dealing with low phosphorous levels, he or she may be have HPT.
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Detailed Look At Symptoms And Dangers Of Hyperparathyroidism
FATIGUE IN PATIENTS WITH HYPERPARATHYROIDISM. The number one symptom that people with hyperparathyroidism complain about is fatigue. Just over 82% of our last 28,000 patients said this was their main problem. Many patients are diagnosed with parathyroid disease because they went to their doctor saying “I’m tired all the time, something must be wrong”. Often the doctor will say “I can’t find anything wrong”, but the patient says “I know my body, and I’m telling you, something is wrong!” Many will say that they noticed “something changed last year”, or”for the past 4 years I’ve been tired and I just thought it was menopause”. A lot of people with hyperparathyroidism say that they are ok in the morning, but by noon they just can’t get going any more. They can’t stay motivated past noon or 1 o’clock in the afternoon. This all makes sense when we understand that our nervous system runs on calcium and when the calcium is high in the blood, this makes our nerves conduct electricity a bit slower–we interpret this as tiredness, fatigue, poor sleeping, poor memory, and other issues regarding how we feel. Almost all patients with a parathyroid tumor will feel remarkably better a week or two after the tumor has been removed. Most say “it was like the fog was lifted from me overnight”. Read our testimonial page to see what other parathyroid patients say about this. This is the best part of our job… our patients love us because we give them back their energy and their “joy of life”.
What Can I Expect If I Have Hyperparathyroidism
Surgery will cure nearly all cases of hyperparathyroidism. If you have surgery, your provider may want to check your calcium and PTH levels six weeks after surgery, and then on a yearly basis. You may also have a bone density test every year as well.
If you have mild symptoms and do not need surgery right now, your provider will carefully monitor your health and order blood tests to check your calcium and PTH levels. He or she will also order tests to watch for bone loss and other tests as needed.
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What Is The Procedure For A Pth Test
Youll need to get your blood drawn for a PTH test.
Before having this test, tell your doctor if you have hemophilia, a history of fainting, or any other condition.
The process of taking a blood sample for testing is called venipuncture. A healthcare provider usually draws blood from a vein from the inner elbow or back of the hand.
Your healthcare provider first sterilizes the area with an antiseptic. Then they wrap a plastic band around your arm to apply pressure and to help your veins swell with blood.
After the veins swell, your healthcare provider inserts a sterile needle directly into the vein. The blood will collect in an attached vial.
When theres enough blood for the sample, they untie the plastic band and remove the needle from the vein. They then clean and bandage the site of the needle insertion if necessary.
Some people experience only slight pain from the needle prick, while others may feel moderate pain, especially if the vein is difficult to locate.
Its common for the spot to throb after the procedure. Some bleeding is also common, as the needle will break the skin. For most people, bleeding is slight and wont cause any issues.
What Are The Symptoms Of Hyperparathyroidism
If you have early hyperparathyroidism, you may not have any symptoms. If you have mild hyperparathyroidism, you may have some of the following symptoms:
Other problems associated with severe hyperparathyroidism include:
- Reduced kidney function, which affects your kidneys ability to filter blood.
- Thinning bones .
- High blood pressure. High blood calcium levels may play a role in the development of high blood pressure.
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What Happens If I Have Too Much Parathyroid Hormone
A primary problem in the parathyroid glands, producing too much parathyroid hormone causes raised calcium levels in the blood and this is referred to as primary hyperparathyroidism. There is a similar but much rarer condition called tertiary hyperparathyroidism that causes hypercalcaemia due to excess parathyroid hormone production on the back drop of all four glands being overactive. Secondary hyperparathyroidism occurs in response to low blood calcium levels and is caused by other mechanisms, for example, kidney disease and vitamin D deficiency.
Mild primary hyperparathyroidism often causes few if any symptoms and is frequently diagnosed by finding a high calcium concentration on a routine blood test. Treatment may be by surgical removal of the affected gland . Further information on the symptoms for each condition can be found in the individual articles.
What Happens If Parathyroid Hormones Are Low
When you have low levels of parathyroid hormone in your blood, it causes you to have low levels of calcium in your blood and high levels of phosphorous in your blood , which cause certain symptoms and health conditions.
Symptoms of low parathyroid hormone levels
Since parathyroid hormone mainly controls the amount of calcium in your blood, which has several important functions, the symptoms youll experience from low PTH levels are actually symptoms of low blood calcium levels. Symptoms of low blood calcium levels include:
- Tingling in your lips, fingers or feet.
- Irregular heart rhythm .
If youre experiencing these symptoms of hypocalcemia, its important to contact your healthcare provider.
When you have too much phosphorus in your blood due to low levels of PTH, it causes your body to pull calcium from your bones to try to keep your blood balanced. This can cause your bones to become weak and unhealthy, which puts you at a higher risk of bone fractures and other issues.
Causes of low parathyroid hormone levels
Low parathyroid hormone levels are primarily caused by hypoparathyroidism, which happens when your parathyroid glands are underactive and dont release enough PTH. Hypoparathyroidism is rare and treatable.
Causes of hypoparathyroidism include:
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How Many People Get Parathyroid Disease
The incidence of parathyroid disease is 1 in 80 people in their lifetime . This rate is much higher in women over 50 where the rate is 1 in 50 or so. If you want to see how common this is, take a look at the map of people we have operated on and you will see that we operated on a neighbor of yours. All of you will know somebody with hyperparathyroidism. Unfortunately, about 70% of patients with hyperparathyroidism do not know they have it they have high calcium levels but their doctors dont know what this means and so the high calcium is ignored. Often, when something bad happens , then the doctors pay attention to the high calcium. Hyperparathyroidism occurs in women more often than men , and the average age is about 59 years oldbut people of any age can get it. Young people do get parathyroid disease, but this is rare. We have an entire page dedicated to this topicRead about Who Gets It?
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How Do Doctors Treat Primary Hyperparathyroidism
Guidelines help doctors to decide whether or not parathyroid surgery should be recommended. You might be a candidate for surgery if you meet any of these guidelines
Doctors most often recommend parathyroid surgery, particularly if the patient meets one or more of the guidelines noted above. It is also not inappropriate to recommend surgery in those who do not meet guidelines as long as there are no medical contraindications to surgery. In those who do not meet guidelines or do not choose surgery, the doctor will monitor the patients condition. If there is evidence for progressive disease , surgery would be advised. For patients who are not going to have parathyroid surgery, even though guidelines are met, doctors can prescribe medicines to control the high blood calcium or improve the bone density.
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Before Taking This Medicine
You should not use parathyroid hormone if you are allergic to it.
In animal studies, parathyroid hormone caused bone cancer. However, it is not known whether these effects would occur in humans. Ask your doctor about your risk.
Tell your doctor if you have ever had:
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high levels of calcium in your blood
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high levels of alkaline phosphatase in your blood
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Paget’s disease or other bone disorders or
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radiation treatment.
Tell your doctor if you are pregnant or plan to become pregnant. It is not known whether parathyroid hormone will harm an unborn baby.
Having hypocalcemia during pregnancy may increase the risk of miscarriage, premature birth, hypocalcemia in the baby, or eclampsia . The benefit of treating hypocalcemia with parathyroid hormone may outweigh any risks to the baby.
You should not breastfeed while using parathyroid hormone. If you do breastfeed, tell your doctor if you notice symptoms in the nursing baby such as fussiness, weakness, stomach pain, poor feeding, vomiting, weight loss, constipation, more wet diapers than usual, muscle spasms, or tremors.
Parathyroid hormone is not approved for use by anyone younger than 18 years old, or by anyone whose bones are still growing.
How Many Parathyroids Are Affected
A scientific study of 6,331 patients with primary hyperparathyroidism examined how many glands typically go bad in this disease. This study included data collected on a portion of patients with this disease over 10 years . The complete data and statistical analysis was published in March 1998 by Dr. James Norman’s group in the Journal of the American College of Surgeons.
The results are as follows:
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95.5% = one enlarged, overactive gland
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4% = 4 enlarged, overactive glands
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0.5% = 2 or 3 large glands
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< 1% = cancer of the parathyroid
Some experts believe the incidence of multi-gland disease is slightly over reported. This data is obtained from patients who have undergone a full neck exploration and had all of the glands biopsied. Therefore, the data is based on a microscopic examination and not on whether any hormone is produced. It is unknown if these other glands would be clinically active .
The only way to know is to remove only one gland while leaving the others untouched and then following these patients for a number of years. The bottom line is that somewhere between 94% and 96% of all patients with hyperparathyroidism have one bad gland and 3 normal glands.
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Why Do I Need A Pth Test
You may need a PTH test if your results were not normal on a previous calcium test. You may also need this test if you have symptoms of having too much or too little calcium in your blood.
Symptoms of too much calcium include:
Symptoms of too little calcium include:
- Tingling in your fingers and/or toes
- Irregular heartbeat
How Do You Fix Parathyroid Disease
Treatment options for the parathyroid disease include monitoring, medication, dietary supplements, and surgery. Surgery is the most effective option to treat the disease. It involves removing overactive parathyroid glands and can be performed either in a minimally invasive way or by a standard neck exploration.
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Symptoms And Signs Of Hyperparathyroidism
- Chronic fatigue / feeling tired all the time
- General feeling of “illness” and “feeling bad” that can be hard to describe
- Lack of interest in activities that you previously enjoyed
- Difficulty concentrating or focusing
- Atrial fibrillation / cardiac arrhythmias
- High liver function tests
- Development of MGUS and abnormal blood protein levels
Most people with hyperparathyroidism will have 5 – 6 of these symptoms or signs. Some will have lots of them. A few people will say they don’t have any… but after an operation they will often say otherwise. In general, the longer you have hyperparathyroidism, the more symptoms you will develop. IMPORTANT, if you do not have calcium levels above 10.0 , then these symptoms are probably not from a parathyroid problem.
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When Should I Get Parathyroid Hormone Testing
The PTH test is often ordered when a blood test shows an abnormal level of calcium or when you have symptoms that suggest there is too much or too little calcium in the blood.
Abnormal calcium levels can be initially detected on a metabolic panel. A metabolic panel is a group of tests that are frequently performed to detect health problems before they cause symptoms. If a blood test shows an abnormal calcium level, a PTH test may be ordered to find out whether it is due to a problem with the parathyroid glands or something else.
PTH testing may also be ordered if you have symptoms that could be related to your blood calcium levels being too high or too low.
If your blood calcium levels are too high, you may experience symptoms that include:
- Increased thirst
- Tingling in the lips, fingers, or feet
- Heart rhythm abnormalities
Ongoing PTH testing may be used in some people who have previously been diagnosed with hyperparathyroidism. PTH testing is also ordered to monitor patients with chronic kidney disease.
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How Do Vitamin D And Phosphorus Affect Calcium Levels In My Blood
Active vitamin D helps to increase the amount of calcium your gut can absorb from the food you eat and release it into your bloodstream. Active vitamin D also prevents calcium loss from your kidneys. In your body, vitamin D is actually a hormone rather than a vitamin.
Your skin mostly produces vitamin D from sun exposure you also get some vitamin D from the food you eat. Your liver and kidneys transform that vitamin D into the active hormone, which is called calcitriol. Parathyroid hormone increases the activity of the enzyme that produces active vitamin D.
The amount of phosphorous in your blood affects the calcium level in your blood. In your body, calcium and phosphorous react in opposite ways: As your blood calcium levels rise, phosphate levels drop and vice versa.
How Is Hyperparathyroidism Diagnosed
Because the symptoms of hyperparathyroidism can be nonexistent, mild or common to many other disorders, a diagnosis of hyperparathyroidism can be missed. Often, the condition is discovered through a blood test that is ordered for another condition.
If you have primary hyperparathyroidism, your blood test will show a higher-than-normal levels of calcium and parathyroid hormone. Your provider may order a sestamibi scan to check for any growths on your parathyroid glands or enlargement of the gland.
Other tests may be ordered to check for complications of hyperparathyroidism. These tests may include:
- A blood test to check your vitamin D level. Its common to have a low vitamin D level if you have hyperparathyroidism.
- A bone density test to check for bone loss.
- An ultrasound or other imaging test of your kidneys to check for kidney stones.
- A 24-hour urine collection test to measure the amount of calcium and other chemicals in your urine to help determine the cause of your hyperparathyroidism.
- Blood tests to check how well your kidneys are working.
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