Recent blood tests and urine tests indicated that I have low vitamin D and high calcium levels in my blood. My family doctor referred me to an Endocrinologist who conducted more tests, and diagnosed my condition as hyperthyroidism. She indicated tha I have an enlarged parathyroid gland and recommended a consultation with a throat surgeon to discuss removal of the gland. I want to find out if surgery is my only action to take, and what other causes and treatments are available for low vitamin D and elevated PTH in the blood. Recent 24-hour urine tests and kidney tests (including kidney xrays) indicate no kidney stones or kidney damage.
I currently suffer from chronic high blod pressure and take four medicines (bystolic, 10mg; benicar HCT 40-12.5; clonidine, 0.1mg; amlodipine, 5mg). My gastroenterologist diagnosed me with gastroperesis, so I take domperidone 10mg (Motioium- four tabs a day), as well as Prilosec OTC once a day for bloating and acid reflux.
Although my family physician just discovered the high calcium level in my blood, I believe it has been elevated for several years. I say this because I have read some of the causes of elevated PTH,
such as arthritis, muscle discomfort in my right side, elevated uric acid, high blood pressure, intestinal problems, and gout, all of which I suffer from time to time. My final concern is whether one of my blood pressure medications ( dieuretic) may be contributing to the elevated PTH in my blood.
I meet with an ear, nose, and throat surgeon tomorrow to discuss the pros and cons of removal of a PTH gland? Pleas let me know what questions and concerns I should convey? I would appreciate you earliest response.
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Thanks for your response. Please see my response to your comments.December 30, 2009 - 4:27pm
According to all of the sources I reviewed (PubMed, MedlinePlus, National Institutes of Health, medical Endocrinology journals..all sources included below), the general consensus is, "Surgery to remove the enlarged gland (or glands) is the main treatment for the disorder and cures it in 95 percent of operations." Other sources concurred, saying, "Surgery for hyperparathyroidism is highly successful with a low complication rate", according to the National Institutes of Health (NIH).
The AACE/AAES (American Association of Clinical Endocrinologists and The American Association of Endocrine Surgeons) POSITION STATEMENT (2005) for the diagnosis and management of Primary Hyperparathryoidism is likely what your surgeon would be referencing; I would ask him/her if the 2005 document is most recent. You can view it online (pdf version) at: http://www.endocrinesurgery.ucla.edu/diseases_treated.html (scroll down to Parathyroid > Primary hyperparathyroidism > More on this topic from the American Assoc of Clinical Endocrinologists (PDF). Also in journal form (at university medical library): [Endocrine Practice, 2005; 11(No1)].
A few different types of surgery are available, and you will find this interesting:
- UCLA Endocrine Surgery: Video on Minimally Invasive Parathyroid Surgery, Advanced Procedures
- PubMed article: Randomized clinical trial comparing open with video-assisted minimally invasive parathyroid surgery for primary hyperparathyroidism (lots of medical jargon)
Drug Therapy Option
There is a new class of drugs called "calcimimetics" that can turn off secretion of PTH, and is approved by the FDA for specific cases (primary hyperparathyroidism due to cancer; secondary hyperparathyroidism due to kidney failure). This drug has not been approved for primary hyperparathyroidism, although some physicians have been prescribing it to their patients. This drug is considered experimental (as of 2005), but one agent specifically (cinacalcet) is effective in lowering PTH concentrations and normalizing serum calcium levels. [Source: Shoback DM, et al. The calcimimetic cinacelcet randomized, placebo-controlled trial. J Clinical Endocrinol Metab. 2004; 89: 3319-3325].
- You would want to double-check this information with your doctor/surgeon, as it may not be the most up-to-date, and ask what the role of this drug therapy could be in your specific situation.
Clinical Observation Option
- Your other choice is "watchful waiting", depending on the severity of your calcium and PTH levels, how many parathyroid glands are affected (part of one, or all four?), and if your other tests and health conditions (ie, kidneys, bone density, etc) are within normal ranges. However, the data says, "no data supports simple observation in the management of PHPT".
Role of Other Medications
- You are right that certain diuretics can cause calcium levels to increase, and this would be a good question for your doctor.
Risks of Surgery
- ("Operative Management" from AACE/AAES Position Statement), state, "...main causes of operative failures are multiglandular disease, ectopic or supernumerary parathyroid glands, parathyroid cancer, and surgical inexperience."
- Knowing these factors, I would personally want to know how many of my parathyroid glands are affected, if I have primary hyperparathyroidism if it is caused by a tumor, and if so, is the tumor benign (non-cancerous), and how experienced the surgeon is with this specific type of surgery.
Bottom line from Position Statement and other Sources
"PHPT remains a relatively common disorder of calcium metabolism that is readily cured by a low-risk operation in 95 to 98% of patients when performed by a qualified surgeon."
Additional Questions you may want to ask:
- If complete removal of parathyroid glands, what are complications? (For instance, hypoparathyroidism?). How prevent complications?
- Drugs that increase levels of PTH?
- Drugs that increase levels of calcium?
- Any supplements or lifestyle changes that the physician/surgeon would recommend?
- How will we know if surgery is successful? What measures are you looking for?
- National Endocrine and Metabolic Diseases Information Service, National Institutes of Health (NIH)
- MedlinePlus: Hyperparathyroidism
- Find a Physician (AACE)
Let us know if we can offer any other information, or if you have follow-up questions! Please let us know what you decide, what information your physician/surgeon provides in your specific situation, and how you are doing!December 29, 2009 - 3:16pm
Thanks for your response. The surgeon is expereinced and indicated that he performs parathyroid surgery at least once a week. I met with him today and he confirmed that I have primary hyperparathryoidism due to possibly an enlarged gland because of a begnin tumor. His first course of action is to request an ultrasound of the glands by the referring Endocrinologist to determine to location of the glands. Based on the ultrasound results, the next test could be a sestamibi procedure, and if necessary, a MRI to determine the "hot spots," as he called them. He wants to do several tests that may take up to 2 weeks before scheduling surgery.
I did forget to ask about the dieuretics and will call and get an answer to this question. Thanks for the reminder. He plans to do a minimally invasive technique but not with the radio-guided technique. The one concern I had was that the surgeon indicated that the parathyroid glands are not always located in the same place in all people. He indicated that a small percentage of people have the glands located near the chest region below the neck!December 30, 2009 - 4:23pm
I appreciate your response and wil keep in touch and keep seeking info about my condition.