? about an elevated parathyroid hormone

I have been having issues with kidney stones and infections for almost 2 months. Due to the antibiotics I have been on, I have not been able to take my vitamins until last week. Today my urologist’s office called me and wants me to meet with an endocrinologist asap regarding an elevated parathyroid hormone. My labs have always been good. I am set to have my next set in a few weeks. I was supposed to have them done yesterday but I had too many scheduling conflicts. For those of you with medical knowledge I have a few questions.

What exactly is elevated parathyroid hormone and what are the consequences of it?

Could this be DS related, not having my vitamins for a month related,  or is it a kidney stone related issue? I have had issues with kidney stones pre WLS and pre weight gain.

Are there any changes to my supplements or diet that I can make to help this?

 

I realize that this is not a doctor forum and I will start harassing my doctors Monday to explain this to me, (they are all gone for the day already) but many of you have been very helpful regarding medical issues in the past.  Thank you for any advice.

An elevated PTH and an elevated calcium level = parathyroid tumor. I found out I had one when I did my pre-op testing and it delayed my surgery by months. However, you are post-op and a high PTH is not unusual. It may mean you need more calcium as a high PTH indicates calcium is being taken out of your bones. You really need to find out what your calcium level is before you panic and remember, a higher PTH for a post DS patient may not mean anything at all (as long as your calcium level is not over 10.2.) Make sure to stress to the endo that you have had bariatric surgery and that you mal absorb. If the endo does not think this matters, run and find one who understands that it absolutely matters.  It took 6 months after the tumor was removed for my PTH to come back down to normal so this may take some time.

On my last labs my Calcium was 9.1 PTH was 50 and D was 49.7.These were taken 6 months ago.  I haven't taken K2 before. What is a good dose to start on? I currently take 2000 calcium, 60,000 D and 1000 K1.

What is the treatment for this? Does it require much time off? I am currently working full time and in grad school full time and in the home stretch. Finals are in 2 weeks and I will graduate in May. I am trying to take the smallest amount of time off possible or at a minimum schedule things for the slowest times I have open.

Thanks again for all your help.

I was expecting you to respond that you had a higher PTH.  I get stones and my PTH was in the 200s.  I never had to take any time off to get it back in other than seeing the endo and going back every 6 weeks for a while to get my blood retested.

Actually, your numbers look fine. No parathyroid tumor to worry about and your PTH isn't terribly high. Your D looks decent but could be a little better.  Just add 100mcg of K2 and see if that helps. You can double it if you need to.

Thanks. That does make me feel better. I am going to add the K2. Do you have any idea what could make the parathyroid high if the other numbers look good?

It is typical for bariatric patients to have a higher PTH than the general population. Yours just isn't high and I don't get why your doc is worried.  Adding the K2 and maybe upping your calcium a bit should take care of the problem for you.  Dr. Norman, the world's leading expert on this topic explains it on his very thorough website: http://parathyroid.com/hyperparathyroidism-diagnosis.htm

This is the advanced page that explains why bariatric patients tend to have a higher than normal PTH. It is about 3/4 down the page. Once you read that, you can go to the home page and read up on parathyroid issues. It is a very well written website. You will see that a PTH level of 65 is considered too high so why your doc is stressing over a level of 50 is beyond me. Of course it may be that you are trending up and he wants to put the brakes on that. My PTH was only 69 when I got diagnosed with hyperparathyroidism but my calcium fluctuated to as high as 11..2, way too high. 

Thank you for the link. This doctor doesn't have my other bloodwork to see a trend yet. When I told them Dr. Houston's office has it done every 6 months they said they would get a copy from him. He does know I have the DS and apparently he is friends with Dr. Houston and said he had heard of the DS but didn't really understand it and he would ask Hugh (Dr. Houston) more about it as it sounded great.

I did not get my PTH into normal ranges until I upped my D to 150,000ius daily, now I take 100,000iu's and am maintaining.  My point being that it is often not just calcium you are deficient in but Vit D, K2 and others.  My maintenance has been good after adding the K2, boron, D and the same amount of calcium.

Talk to your endo like mentioned and make sure that he knows the percentages of malabsorbtion you have for fats. (approx 80% of fat is malabsorbed)

HTH,
Michele

You know, come to think of it my PTH finally settled down once I added K2 to the mix. I hadn't thought about that before because my surgeon and PCP both warned me it would take that long for my PTH to return to normal.  With a parathyroid tumor vitamin D levels drop painfully low so I was supplementing with high doses of D but it wasn't until I added the K2 that it finally resolved.