Patient's Query
Hello doctor,
My father recently underwent blood and urine tests. His calcium level is high (11.98 mg/dL), and PTH (parathyroid hormone) is elevated at 73.20 pg/mL. 24-hour urine calcium is also high (331.5 mg per day). Vitamin D is low. We are seeking expert evaluation for likely primary hyperparathyroidism (PHPT) diagnosis, advice regarding vitamin D supplementation, and treatment options, including surgery or medication. Please advise on the next steps and management plan.
Thank you.
Hi,
Welcome to icliniq.com.
I can understand your concern.
Before coming to the diagnosis of primary hyperthyroidism, I would like to know whether your father is having any symptoms or if the tests were done as a general checkup. Secondly, you have mentioned that PTH (parathyroid hormone) is high, but in the report, it is within the range; there is a need for clarification on that. Kindly revert with these.
I hope this information will help you.
Thanks.
Patient's Query
Hello doctor,
Thank you for your reply.
1. These tests were done during a general health checkup. We do annual tests every year, and my father’s calcium levels have always been high in past reports, too. He feels very fatigued and weak, but no major problems like kidney stones or fractures yet.
2. About the PTH (parathyroid hormone), you are right that it is within the lab’s normal range. However, since his calcium level is high (11.98 mg/dL), we understand that the PTH level should normally be low when the calcium level is high. Since it is not low, it is called inappropriately normal and points toward primary hyperparathyroidism.
Kindly guide us on the next steps.
Thank you.
Hi,
Welcome back to icliniq.com.
I can understand your concern.
You are right; high calcium levels, a low, normal, or low PTH (parathyroid hormone) would have been appropriate, and since it is high normal, we consider it inappropriately normal PTH. Now, what to do next is the question. Since he is asymptomatic, there are two ways to approach this issue:
1. Wait and watch: Repeat serum calcium and PTH intact after three months. If the PTH value increases, we can proceed to further testing to evaluate primary hyperparathyroidism. If the PTH value does not increase and the patient does not have any symptoms, we can continue the wait-and-watch policy.
2. Start evaluation now: This requires certain scanning, which helps in confirmation of the diagnosis of primary hyperparathyroidism and also in helping determine whether the patient needs surgery or medical management. I recommend USG (ultrasonography) of the neck and a Sestamibi scan. Both options are fine, but in my opinion, you can go with the wait-and-watch. Another advice is to get a DEXA (dual-energy X-ray absorptiometry) scan done to check whether any bone weakness is due to hyperparathyroidism; bone weakness increases the risk of fractures, especially of the spine. In such cases, going for a Sestamibi scan is also recommended. He can take vitamin D Supplementation weekly once for four months.
I hope this information will help you.
Thanks.
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Answered byDr. Divakara. P
Medically reviewed byiCliniq medical review team
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