My calcium is 11.9 mg/dl. Ionized calcium is 5.7. Parathyroid hormone (PTH) is 65. Random urine calcium is 11.9. I have an overwhelming overall discomfort/pain. It’s so bad I can’t work anymore. Do I have hyperparathyroidism? I am 62 years old.
Your labs are classic for primary hyperparathyroidism.
A diagnosis of parathyroid disease is based on labs, specifically calcium and PTH levels. At your age, your calcium levels should be in the mid to high 9s (in mg/dl) range. A calcium of 11.9 mg/dl is definitely high. Most of the time, high calcium is caused by parathyroid disease, but not always. To confirm the diagnosis, we need to evaluate parathyroid hormone (PTH) levels. Your parathyroid hormone is on the high end of “normal range,” which is inappropriate for a high calcium.
The parathyroid glands respond to high calcium levels by stopping PTH production. They essentially “shut down” and stop putting out PTH so that the calcium level can drop back down. If the calcium level is high, but your parathyroid glands are still making a “normal” amount of PTH, then there is a problem with the parathyroid glands. We diagnose primary hyperparathyroidism when the calcium is high and the PTH is high or in “normal” range (because it isn’t actually normal if your calcium is high).
The random urine calcium is not that important for the diagnosis. A slightly more accurate picture would come from a 24 hour urine, but even that is often not helpful in the diagnosis. Patients with primary hyperparathyroidism can have normal, high, or even sometimes low urine calcium levels, so the urine calcium doesn’t help us make or rule out a diagnosis.
Primary hyperparathyroidism often causes non-specific symptoms like fatigue, brain fog, body aches, and insomnia. These can significantly affect your quality of life. If untreated, parathyroid disease can also lead to kidney damage, cardiac arrhythmias, hypertension, and osteoporosis.
The only cure for primary hyperparathyroidism is an operation to remove the diseased parathyroid gland or glands. Most of the time, primary hyperparathyroidism is caused by a parathyroid adenoma, a benign tumor on one or more of the parathyroid glands. Removing the diseased gland fixes the problem. Most patients notice dramatic improvement in symptoms after parathyroid surgery.
