Top 5 Things to Know about your Parathyroid when you have High Calcium Levels

One of the most common labs that is checked is a calcium level. Calcium levels are checked routinely when you have most lab work as part of your annual physical exam, or even if you see a doctor for just about any reason. Calcium levels are always checked because they are one of the most important electrolytes in your body. Calcium is critical in making sure that muscles and bones are healthy and work well, and can even affect how you think and feel. In short, having abnormal calcium levels can be very detrimental to your health and well being!

What most people don't know, however, is that your calcium is primarily regulated by your parathyroid glands. In this setting, when your calcium levels go up, your parathyroid glands will secrete less parathyroid hormone. The opposite also happens: when your calcium levels go down, your parathyroid hormone levels (also known as PTH) should go up, which causes your body to get more calcium from the food that you eat and even from your bones. Over time, this homeostasis of calcium levels is critical to making you feel well, and also protecting you from the chronic complications of too much or too little calcium in your blood.

In honor of the role of calcium in your body and its importance in helping you achieve optimal health, here are 5 things you should know about your calcium levels and how they have to do with your parathyroid glands!

1- High calcium levels with low parathyroid levels can be concerning because they might indicate a more serious condition. A situation like this demonstrates that your parathyroid levels are responding appropriate to high calcium... but it makes us worry why your calcium is high. Sometimes this can be a sign of cancers or other processes that affect your bone health. If you have high calcium but low parathyroid hormone levels, make sure to talk to your doctor.

2- High parathyroid hormone levels (PTH) with low calcium represents a condition known as secondary hyperparathyroidism. We call this secondary hyperparathyroidism because the changes in PTH are secondary to (or caused by) another condition. Secondary hyperparathyroidism can be caused by many things, but some of the most common include kidney problems or even just low Vitamin D. Another common cause can be biotin supplements, or even some common medications such as lithium. If your PTH levels are high but your calcium is low, you do not need parathyroid surgery, but you do need to figure out why and how to improve the levels.

3- Primary hyperparathyroidism is when your calcium and your PTH values are both elevated at the same time. This condition can be confirmed with lab tests, and we will usually also check a Vitamin D level to make sure that those are fine because they are so commonly abnormal. The cure for primary hyperparathyroidism is surgery. While medications can help to adjust your lab values, they are not curative.

4- Primary hyperparathyroidism is caused by a mutation in your calcium sensing receptor, or CaSR. Such a mutation is most commonly found in a single parathyroid gland, almost as if your thermostat wasn't working. As above, removal of the broken thermostat is sufficient to fix the problem for most people (because the other glands then work normally and regulate calcium appropriately).

5- Surgeon experience is the most important thing you can find when you are trying to fix a broken parathyroid gland. The reason for this is that about 20% of people with a parathyroid problem will require a more advanced surgery- and your surgeon may not know that until they are in the middle of surgery. If they don't have the experience to adjust in the middle of surgery, you may end up needing another surgery. Reparative parathyroid surgery is much more challenging as well. Things to ask to know if you have an experienced surgeon: How many parathyroid surgeries do you do each year? (should be more than 100), What other techniques do you offer? (you want to talk about scarless parathyroid surgery and if it's right for you, and they should do this regularly or they are likely to tell you that it doesn't apply to your case), Will I need general anesthesia? (many parathyroid surgeons insist on general anesthesia, while experienced surgeons will often do this procedure under twilight anesthesia or even local anesthesia).

While there are many more thing to consider your calcium levels are elevated, this is a good baseline of the top 5 things that you should know about your calcium levels and how PTH affects them. Let us know if we can help!

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