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Is it common for PTH levels to fluctuate after removal of 1 parathyroid gland? I had surgery and a week later, my PTH was at 96.7. Calcium and Vit D were closer to normal.

Deva Boone
Answer authored by Deva Boone
Deva Boone, MD is the founder of the Southwest Parathyroid Center. As one of the most experienced parathyroid surgeons in the U.S., she has treated thousands of patients with parathyroid conditions.

The simple answer is yes, it is common (and even expected) for PTH levels to fluctuate after surgery.

Right after a parathyroid tumor is removed, PTH levels plummet. If the other parathyroid glands are normal, then they are dormant, and making very little PTH. A day after surgery, I expect the PTH level to be low. Calcium levels drop soon after that as a result of the drop in PTH. In the week or two after surgery, the remaining parathyroid glands then respond to that drop in calcium, and start making more PTH. If you check labs at this point, you might see a low or low-normal calcium level, with a high PTH level. As the weeks progress, things settle out, and usually by four weeks after surgery the calcium and PTH are both within normal range.

It is always important to look at both the PTH and calcium together. If your calcium was 8.9 mg/dl when they checked your labs, then I would expect to see a PTH like 97 pg/ml. That is an appropriate PTH for a low calcium. If your calcium was 10.5 mg/dl, then I would be concerned that you had another parathyroid tumor, because that calcium should suppress normal parathyroid glands. If they are not suppressed, that usually indicates a problem.

For now, I would recommend waiting and letting the labs settle out. I usually check labs about 6 weeks after surgery, because by that point they should give a more accurate picture. If the PTH is still high, and the calcium is low, then you likely need more calcium and Vitamin D. If the PTH is still high, but the calcium is also high, then I would be concerned about persistent primary hyperparathyroidism.

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