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Diagnosis

Diagnosing parathyroid disease is straightforward in many cases, but not all. Many patients are challenging to diagnose, and may be misdiagnosed for years. Getting an accurate diagnosis is the first and most important step in treating parathyroid disease.

My calcium is always noted to be “high-normal” but doctors are not concerned. Could I have parathyroid disease?

<p>Great question! To figure out whether you might have parathyroid disease, I would want to see the actual calcium levels. If a calcium is "high-normal" but is in the truly normal range, then parathyroid disease is unlikely. <strong>Unfortunately, often what is called "high-normal" is actually just high, and that indicates likely parathyroid disease. </strong> </p> <p> The question then is,...

Normal calcium Primary HPT Diagnosis

I have had high calcium levels for over 30 years, but have never been diagnosed with parathyroid disease. I’ve never had any health problems. Do I have primary hyperparathyroidism?

In most cases, persistently high calcium levels indicate primary hyperparathyroidism. But we need more information to confirm the diagnosis. To diagnose primary hyperparathyroidism, we check the calcium and PTH together. If something else (not parathyroid disease) is causing the high calcium, then the normal parathyroid glands will be suppressed - that is, they will make very little hormone. Th...

FHH Diagnosis Primary HPT Hypercalcemia

Do you need to correct your calcium based on albumin levels? My doctor told me that my high calcium level was actually normal once he corrected for albumin.

The short answer is that you cannot “correct” a high calcium down to normal by looking at albumin. We use albumin to correct for low calcium levels. But this is a tricky issue, which requires a longer explanation. First, let me explain how calcium and albumin are related. Calcium in the blood can be free (not bound to anything) or bound to albumin. The free calcium is the ionized calcium, which...

Albumin Normal calcium Diagnosis

I was just told that my PTH is 90 pg/ml (normal up to 65 pg/ml). Does this mean I have parathyroid disease?

To interpret this, we need more information. A PTH of 90 is above the "normal" range, but we cannot yet give a diagnosis because we need the calcium level. PTH should only be interpreted in the context of calcium levels. The parathyroid glands make PTH in order to regulate calcium levels. If the blood calcium level is low, then the parathyroids will make more PTH in order to get the calcium ...

My calcium levels have been normal (around 9.5 mg/dl) but my PTH is consistently elevated, between 60 to 80 pg/ml (normal range up to 65 pg/ml). Do I have parathyroid disease?

Most of the time, this clinical picture does not indicate primary hyperparathyroidism. The PTH is a little bit over the "normal" range, but with calcium levels that remain in the normal range, a parathyroid tumor is unlikely. If your calcium level were high (that is, over around 10.0 mg/dl for adults over age 40), then I would diagnose primary hyperparathyroidism. But with normal calcium levels...

Diagnosis Secondary HPT

Over the last 5 months my calcium levels have been above 10.0 mg/dl, up to 10.3 mg/dl. My doctor tells me this is normal. I'm 75 years old, and my calcium levels before this were always between 9.1 and 9.7 mg/dl. Why is my calcium rising?

At your age, a calcium of 10.3 mg/dl (2.57 mmol/l) is too high. Most adults over about age 40 should have calcium levels in the mid to high 9s, up to 10.0 mg/dl (2.5 mmol/l). Sometimes adults in their 40s will still have calcium levels in the low 10s, but generally these levels drop as you age. By the time you are 75, you should not have any calcium levels above 10.0, especially if your calcium...

Normal calcium Diagnosis

My teenage daughter was recently found to have a calcium of 10.5 mg/dl. The lab says this is high, and her doctor says that she probably needs surgery to remove a parathyroid tumor. What do you think?

A calcium of 10.5 mg/dl (2.62 mmol/l) is normal for a teenager. Teenagers have higher calcium levels than older adults. While a calcium of 10.5 would definitely be high for a 50 year old, it is within the normal range for children and teenagers. Your daughter's lab is not correcting for her age. Her calcium level does not indicate a parathyroid tumor, and so she does not need surgery.

Normal calcium Diagnosis

Three years ago I had a parathyroid tumor removed. I did very well, but recently my PTH has gone up to 85 pg/ml (normal range up to 65 pg/ml). Do I have another parathyroid tumor? My last calcium was 9.1 mg/dl.

Your labs are now more consistent with secondary hyperparathyroidism (not primary hyperparathyroidism, which is what you had three years ago). That is, the parathyroid glands are making more hormone in response to a low calcium level. Ideally you want your calcium level to be closer to the mid to high 9s in mg/dl. Your remaining parathyroid glands are doing exactly what we want them to do when ...

Postop expectations Diagnosis Secondary HPT

I have been having difficulty swallowing, along with a soreness and tightness in my neck. I can also feel a lump in my neck. I had a thyroid ultrasound, which showed a possible thyroid nodule vs. parathyroid adenoma. Could I be feeling the parathyroid adenoma?

It is usually nearly impossible to feel parathyroid tumors. Even when large, they tend to be soft and squishy, and don't cause pain. Sometimes, if you have a large and deep adenoma, you can feel something when swallowing, though this rarely causes actual difficulty swallowing. What you are describing actually sounds more like thyroiditis, or an inflammatory condition of thyroid. The most co...

Thyroid nodule Thyroiditis Diagnosis

I have been following my calcium levels for the last few years, and they seem to fluctuate a lot. I read that this could indicate parathyroid disease. My calcium levels over the last four years were as follows: 9.7, 9.2, 9.1, 9.8, 9.9, 9.1. Do you think I have parathyroid disease? I'm a 52 year old man.

As long as your calcium levels are staying in the normal range (which they are), then some fluctuation is normal. In general, your parathyroid glands do try to maintain a relatively steady calcium level, but this does not mean that the level will be exactly the same every time it is checked. Your labs appear completely normal. My answer would change if you had calcium levels fluctuating int...

Normal calcium Diagnosis

My calcium level has been high-normal for the last two years. My PTH level is high (85 pg/ml). My doctor says I do not need to be concerned because the calcium is still normal - around 10.2 mg/dl. I'm a 73 year old woman. Do I have parathyroid disease?

For your age, this calcium level is not "high-normal" - it is high. A normal calcium range for someone in her 70s would go up to about 10.0, not higher. While I cannot diagnose someone over the internet, I can say that in general, multiple calcium levels over 10.0 and a PTH of 85 in a woman in her 70s are consistent with a diagnosis of primary hyperparathyroidism. Even though your calcium l...

Normal calcium Diagnosis

Last year I was diagnosed with parathyroid disease. My doctor recommended just watching it. Last year my calcium was 10.5, but now it is 9.8 and my doctor says that I don't have parathyroid disease. Does it sometimes go away without treatment?

Primary hyperparathyroidism does not resolve on its own, but the calcium levels can fluctuate back into the normal range. This does not mean that the diseased parathyroid glands have improved. Diseased parathyroid glands act inappropriately; they often don't make a steady amount of PTH. Some days they dump out more PTH, some days less. The PTH thus fluctuates, and so the calcium fluctuates. Thi...

Normal calcium Diagnosis

My doctors can't figure out what is going on with me. My calcium levels have been between 9.8 and 10.5 mg/dl over the last year. My PTH was 25 pg/ml. My Vitamin D was 89 ng/ml. I was diagnosed with a Vitamin D deficiency years ago so I have been taking 5000 units of Vitamin D daily since then. My doctor isn't sure if I have a parathyroid tumor or not. I've been feeling all of the symptoms of parathyroid disease and think this is what is wrong. What do you think?

This clinical picture looks typical for overuse of Vitamin D. One of the main roles for Vitamin D is to help your intestines absorb calcium. Vitamin D is a fat soluble vitamin, so it builds up in your body over time. You are currently on a very high dose of Vitamin D, which is why your Vitamin D level is high. Your lab might not label your Vitamin D as being in the "toxic" range, but it is high...

Vitamin D Diagnosis

I recently had a very painful kidney stone and want to prevent that from ever happening again. I read that primary hyperparathyroidism can cause kidney stones. How can I figure out if that is what is going on?

If you've had a kidney stone, I definitely understand the desire to avoid another one! Primary hyperparathyroidism can cause kidney stones, and it is appropriate to evaluate for this in anyone who has had a stone. The first thing to do is check your blood calcium levels. If you have a high calcium level, then this could be the cause of your kidney stones. You would then want to check calcium an...

Symptoms Kidney stones Diagnosis

I have all of the symptoms of parathyroid disease. I'm exhausted, can't concentrate, have back pain, can't sleep at night, and just feel awful. I discovered parathyroid disease and it seems to account for all of my symptoms over the last year. My calcium level, though, was normal at 9.8 mg/dl. My doctor checked a PTH and it was 43 ng/ml. She says I don't have parathyroid disease. Could I still have it, even with normal labs?

Your symptoms are consistent with the common symptoms of primary hyperparathyroidism, but with normal calcium and PTH levels that is not likely to be your underlying problem. We diagnose parathyroid disease with labs: primarily calcium and PTH; Vitamin D is also helpful in many cases. If the calcium and PTH levels are consistently normal, then parathyroid disease is very unlikely. The one t...

Diagnosis Normal calcium

Is this primary hyperparathyroidism? Over the last year my calcium levels have been: 10.5, 10.9, and 10.6 mg/dl. My PTH was 57 pg/ml. I'm 75 years old. My physician said that my PTH is normal and so this cannot be primary hyperparathyroidism.

These are classic labs for primary hyperparathyroidism. Your calcium is high for your age. PTH levels can only be interpreted in relation to calcium levels. If your calcium is normal, then you expect the PTH to be in the "normal" range listed on the lab result. But if the calcium is high, normal parathyroid glands will be suppressed, and thus the PTH should be low (under 20 pg/ml). If the PTH i...

Diagnosis Hypercalcemia FAQ

What is Parathyroid Disease?

Parathyroid disease refers to problems with the parathyroid glands. Almost everyone has four parathyroid glands, located in the neck near the thyroid. These glands exist to regulate blood calcium levels, so parathyroid disease is fundamentally a problem of calcium. The calcium in your blood is kept in a very tight range - your body doesn't want it too low or too high. The parathyroids are what ...

Diagnosis Primary HPT Secondary HPT Popular Parathyroid Disease Basics FAQ

How do I know if I have parathyroid disease?

We diagnose parathyroid disease using lab tests, particularly calcium and parathyroid hormone (PTH) levels. (If you know your calcium and PTH, you can use the <a href="https://www.southwestparathyroid.com/app" target= "_blank">Parathyroid Analysis Tool</a> for an assessment of what your labs mean.) A high serum calcium level (checked on routine labs like a Basic Metabolic Panel or Comprehens...

Diagnosis FAQ Popular

Hi Dr Boone. I have high calcium. Does it mean I have parathyroid disease? Also your website doesn’t mention primary parathyroid disease. Is it by design? Thanks.

High calcium is almost always caused by parathyroid disease (specifically, primary hyperparathyroidism), but just knowing a calcium level is not enough for a definitive diagnosis. We also need to see a PTH level. Once you have a calcium and PTH level together (ideally taken from the same day), you can usually make the diagnosis. A high calcium combined with a high or normal PTH is diagnostic of...

Diagnosis Primary HPT

Do you have any thoughts on why there are so many varying opinions on what lab values actually confirm a diagnosis? For example many very well respected experienced surgeons and endocrinologists correct calcium for albumin even when it’s not low. This can bring a high calcium down to normal or even low and possibly miss a diagnosis.

It's a great question. It seems like we should all be able to agree on which lab values are normal. Unfortunately this is not the case, and there are a few reasons. First, when the lab gives the results, it gives a "normal range" - but this is looking at all humans in aggregate. A normal human can have a calcium of 10.5 mg/dl when she is 20 years old, but should not have that when she is 80...

Diagnosis Normal calcium Albumin

I have been diagnosed with Primary Hyperparathyroidism and Osteoporosis. I had a 4D CT on the parathyroids and it was normal. Do you think a Sestamibi scan or another test will be better for diagnose or should I wait until my next blood check to see if my Vitamin D3 helped. My endocrinologist said I don't need to take calcium supplements and just keep taking the vitamin K and my ENT doctor said I'm not a good candidate for surgery based on the 4D CT results. I will have the surgery If I can get better. What do you think about my tests levels? My calcium is 9.1 mg/dl and PTH 91 pg/ml. Based on your Analysis Tool I have Secondary Hyperparathyroidism not Primary. Can you please help me?

There are really two separate questions here: 1. What do I do if the 4D CT scan does not show a parathyroid tumor? 2. Is this primary hyperparathyroidism or secondary? For the first question: 4D CTs, or any other scan used to find parathyroid tumors, are not used to diagnose parathyroid disease or determine whether you need surgery. We use lab results to diagnose primary hyperparathyroidi...

Diagnosis Imaging

I had a calcium level of 10.6 and then 10.4 on a recheck a week layer. PTH is 58. I am 56 years old. I will discuss with doctor. He might say it is normal and to monitor. Any thoughts?

Thanks for posting your question! From the information that you have given, it looks like you have parathyroid disease. At your age, calcium levels of 10.6 and 10.4 mg/dl are definitely not normal, and usually indicate primary hyperparathyroidism. To diagnose this, we also need the PTH level. Your PTH level is in the higher end of normal, which means that you have primary hyperparathyro...

Diagnosis Primary HPT

I am a 31 year old female and my calcium level just came back at 10.4. My albumin and chloride were also slightly elevated. Should I be worried about parathyroid or what next steps should I take as precaution? I'm on 5000 units daily of Vitamin D3.

At your age, a calcium of 10.4 mg/dl is borderline. Adults in their 30s can have calcium levels in the low 10s, which will tend to drop down into the 9s as they get older. A calcium of 10.4 is on the highest end of where I would expect your calcium levels to be at your age. I am concerned about your dose of Vitamin D. 5000 units daily is a lot, and if you have been on that dose for a long t...

Diagnosis Vitamin D

I have been feeling very sick. My PTH intact level is 134.4 pg/ml and my calcium is 11 mg/ld. Also I have blurry vision and just feel really sick.

Thanks for writing in. I'm not surprised that you are feeling badly. Your calcium and PTH indicate primary hyperparathyroidism, and most people with this will develop symptoms. The most common symptoms are often non-specific, things like fatigue, insomnia, and brain fog. People also report that they just don't feel like themselves anymore. They feel generally unwell, though it might be hard to ...

Diagnosis Symptoms

What does it mean when your Calcium is 10.7 mg/dL and your Albumin is 4.9 g/dL?

There are two main issues here. First, what does a calcium of 10.7 mg/dl mean? And second, does the albumin change that? Let's address the calcium first. If you are over the age of 30, then that calcium level is high. The most common cause of high calcium is primary hyperparathyroidism. To make that diagnosis, we first have to look at a calcium and PTH level together. If your calcium is hig...

Diagnosis primary hyperparathyroidism Vitamin D Albumin

I believe I've had primary hyperparathyroidism for at least 12 years. I am 73. I also have low Vitamin D in the 26 range. Twice over the years and currently I've been prescribed high doses of vitamin D which does raise my Vitamin D level to 40 ng/ml or within normal range, but each time it also raises my PTH. I was given 50,000 IU of D weekly for 2 months and my PTH went up to 140 pg/ml, not down. I'm now on 4,000 daily of Vitamin D and my PTH has gone up to 174.2-147.4. Why would my Vitamin D going up also cause my PTH to go up? My Calcium stays consistent at 10.2-10.5 mg/dl.

Great question! The short answer is: You have primary hyperparathyroidism, so Vitamin D is not going to fix your problem. Taking Vitamin D will not be able to overcome the parathyroid tumor. The only way to cure this is with parathyroid surgery, to remove the diseased parathyroid gland(s). Long answer: A lot of doctors will see low Vitamin D levels and high PTH levels and prescribe Vita...

Diagnosis Vitamin D

What type of doctor do I need to diagnose primary hyperparathyroidism?

Most people will be diagnosed by their primary care doctor or by an endocrinologist. You do not necessarily need to see a specialist to diagnose primary hyperparathyroidism, but if there is any question, your doctor will likely want you to see an endocrinologist or an endocrine surgeon. Since primary care doctors are often the ones checking routine labs, they are usually the first to notice ...

I am 69. My calcium levels have run consistently 10.8 range for the past 2 years. It has been 11.9 and 11 as recently as a few days ago. My PTH was 86 in September 2021 but is normal range now. However I feel really bad. Fatigue, difficult concentration, tingling lips, constipation, absolutely no appetite with weight loss, nervous internally and eye sight changes. Could I have parathyroid issues even with a normal PTH? I have seen doctors but they just say they don't know why my calcium is high or what is causing my symptoms. My whole life has changed. I'm desperate for answers and where to find them. Please help.

Your lab results indicate primary hyperparathyroidism. You are experiencing the classic symptoms of the disease, which should improve once you get it treated. The diagnosis of primary hyperparathyroidism is based mostly on calcium and PTH levels, but you do not need to have a "high" PTH to make the diagnosis. The important thing is the calcium and whether the PTH is appropriate given the ca...

Diagnosis Hypercalcemia primary hyperparathyroidism

Why would my serum calcium be high but Ionized calcium low? Does low ionized calcium mean no parathyroid issue? Should I follow-up or wait for next year annual blood work? I'm 66 years old. Recent blood work showed: Serum Calcium: 10.5 mg/dl Follow-up 1 week later (non-fasting): Ionized Calcium = 1.08 Vit D = 32 ng/ml PTH = 37.8 pg/ml

Most commonly, the total serum calcium and ionized calcium will show a similar pattern - that is, they will both be on the high end or both on the low end. But not always. There are multiple factors that could make one or more of these results less reliable. Total calcium levels depend on albumin, so a low albumin can give you a falsely low calcium level. Ionized calcium levels depend on the pH...

Hi, Dr Boone, Thanks so much for accepting questions! I found you through Lani Simpson's Master Class. My PTH has been between 24 and 44, calcium between 9.1 and 9.5, phosphorus between 3.9 and 4.3 and vitamin D between 47 and 64 over the last 4 years (I've been on vitamin D supps for at least 2 decades). I could dig up numbers from the years before, but I don't think there was ever much difference. Reason I'm asking is that I lost 19% of my forearm bone density over the course of those 4 years (11% at spine, and 1.5% at hip). No gastric bypass, I'm an omnivore, no diarrhea. Kidney function normal. I take only 40mg calcium in the form of bone meal. The reason I take so little is that 2-3 years ago, when I did a 24h urine calcium test while taking 400mg calcium supp a day and DIDN'T stop taking it when doing the test, I was at 301 (whatever the unit is). Then I repeated that test 2 months later, and didn't take any calcium supp, and the result was 205. Both my doctors told me it was unnecessary to take calcium supps in that case. I "compromised" and kept taking 40mg. I just want to cover my bases by making sure whether or not I'm losing so much bone because of my parathyroid, since this affects any kind of treatment plan.

Hi, thanks for writing in! If you are in Lani's group then you are in good hands. Parathyroid disease often causes bone loss, and the most severe bone loss in parathyroid disease is often seen in the forearm. That is, when someone with parathyroid disease gets osteoporosis, we often see the worst numbers in the forearm, or radius, as opposed to the femur or lumbar spine. So when someone has...

Diagnosis Osteoporosis

My blood test showed my calcium at 9.5 but a 24 hour urine test my calcium was 523. Why the difference?

Let's start with what each test is measuring. Blood calcium tests are checking for the concentration of calcium in your blood. In the US, the result is given in milligrams of calcium per deciliter of blood, or mg/dl. Your blood calcium concentration is 9.5 mg/dl. Your 24 hour urine calcium result is giving the total amount of calcium that is going into your urine over a 24-hour period. The ...

I’m 67 and my Calcium is at 10.4. I’m breast cancer survivor 20 years. What should I do?

Thanks for reaching out. A calcium of 10.4 mg/dl is high for your age. Most of the time, a high calcium level is caused by primary hyperparathyroidism. Certain cancers, including breast cancer, can also cause high calcium, but this is much less common. Fortunately, it is easy to determine whether the high calcium is caused by parathyroid disease or something else, by checking the parathyroi...

Diagnosis Hypercalcemia

My blood report reads: Calcium 10.4, PTH 85.3, Vitamin D is 58.5, Albumin 5, Calcium Ionized 5.19. I am 58 years old. I have stopped taking 5000mg of Vitamin D, tho my doctor said I should have an MRI to see which thyroid needs to be removed. Does this make sense? Thank you very much.

Thanks for writing. Your blood tests indicate that you have primary hyperparathyroidism. You have a calcium level that is high for your age, with a high PTH. Most of the time, primary hyperparathyroidism is caused by a benign parathyroid tumor, or adenoma. The treatment for this is removal of the parathyroid tumor. Sometimes, imaging can show which parathyroid gland is diseased. Your doctor...

Diagnosis Imaging Hypercalcemia primary hyperparathyroidism

I'm an adult female and have had elevated serum calcium for a few years ranging from 10.4 - 10.8 (mg/dl), however my ionized calcium from the same blood draws has been either normal or only the slightest bit above normal. My PTH ranges from normal to in the 80s (pg/ml). Which calcium is more accurate in my case - the serum total or the ionized? All other serum values are normal (metabolic, phosphorus, D.) Thank you!

Great question! Usually when we check calcium levels, we are checking the total serum calcium. This is the level that is included in a metabolic panel (basic or comprehensive), one of the standard lab tests that you will have if you are simply getting "routine labs." Calcium is present in your blood in two forms: 1. Ionized, or "free" calcium, that is floating around as a calcium ion. 2. Bo...

Diagnosis Hypercalcemia primary hyperparathyroidism

Primary Parathyroid issue since 2016. Endocrinologist wants me to take Sensipar. I have osteoporosis on wrist on dexa scan. I am debating what is the best option for me as I got told that I might have all 4 glands involved. On scan it looks like left upper one but images are not great. In past I follow Mayo clinic and just wait and watch game. Do you have any advice for me? I am from Iowa. My calcium level is not high but in range of 10-10.5 mg/dl, Vitamin D is always low. PTH between 80 to 129 pg/ml. I am 75 years old.

Your labs are diagnostic for primary hyperparathyroidism, with elevated calcium and PTH levels. Low Vitamin D is also classic in primary hyperparathyroidism. The only cure for primary hyperparathyroidism is an operation to remove the abnormal parathyroid gland or glands. Sensipar is a medication that can reduce your calcium and PTH levels. It will make your labs look better on paper, but wi...

Operation Diagnosis

I just received my test from my bloodwork and wanted to know if I should be worried about a calcium level that was 10.3 mg/dl?

If your blood calcium level is 10.3 mg/dl, it's important to consider several factors before determining if there is cause for concern: Age: Calcium levels tend to decrease slightly with age. If you are in your 20s or 30s, a calcium level of 10.3 mg/dl can be within the expected range. However, if you are 40 or older, it is less common to see levels above 10.0 mg/dl. Most of the time, persis...

Diagnosis Hypercalcemia

My calcium is 10.5 mg/dl, my PTH is 53 pg/ml, my Vit D 25-hydroxy is 21 ng/ml. My doctor wants to start me on Vitamin D daily. Everything I’ve read says not to treat the low Vitamin D, if this could be primary hyperparathyroidism. Not sure what to do! How is taking Vit D going to lower my calcium level? I am 47 years old.

Let's summarize your results: Calcium at 10.5 mg/dl is elevated for your age. PTH at 53 pg/ml is not suppressed, which is inappropriate for the elevated calcium level. Vit D 25-hydroxy at 21 ng/ml is on the lower side. These numbers strongly suggest primary hyperparathyroidism (pHPT). In the context of pHPT, taking Vitamin D supplements is not the recommended course of action. Why? Bec...

Hypercalcemia primary hyperparathyroidism Diagnosis Vitamin D Vitamin D deficiency

Hi, last week I learned my calcium level was 10.6 mg/dl, my pth level is 49 pg/ml, vitamin d level 29 ng/ml. My doctor wants me to start taking 1000mg of vitamin d. I’m reading that this is dangerous and most likely it’s parathyroid disease/tumor. Could you help me with this? I’ve never taken calcium or vitamin d. I’m 68 years old.

Thanks for reaching out. I'm glad that you are researching your health condition and taking control of your care. Your lab results show an elevated calcium level and non-suppressed PTH level, which indicates that you have primary hyperparathyroidism (pHPT). The relationship between the calcium and PTH is essential here; in the presence of elevated calcium, the PTH should be suppressed if th...

Diagnosis primary hyperparathyroidism Vitamin D

Should I be taking Vitamin D? I am a 53 year old man. I had parathyroid surgery in 2/2023. Prior to surgery, my calcium levels had been high, 10.1 to 10.9 mg/dl for the previous 3 years. Upon diagnosis I was told to take Vitamin D3 (3000 IU) daily. In 6/2023 I began having neck pain and dizziness. My PTH was measured at 121 pg/ml, with Calcium 10.7 mg/dl. In 10/20/2023 I stopped taking Vitamin D3. In 11/23 I was feeling abnormal. Dysphagia came back, very frequent urination etc. I requested labs as a result and my blood calcium came back as 10.7 and PTH was 53, the lowest in 2 years (since being measured). Yet, I feel worse than ever. Should I resume D3? I just do not know. Thank you.

Thanks for writing in. Typically I recommend taking calcium and Vitamin D after parathyroid surgery, but in your case I would advise against it, since your calcium is still high. Unfortunately, your lab results indicate that you still have primary hyperparathyroidism (pHPT). The calcium level is high for your age, and the PTH is not suppressed, which is inappropriate for the elevated calciu...

Operation Diagnosis Vitamin D

My brother is 33 years old. Last year his calcium level was 10.4 mg/dl and this year its 10.3. Should we be concerned since it is above 10? Should we request the doctor to do more lab tests?

At 33 years old, a calcium of 10.3 mg/dl can be normal. It's on the higher end of normal, but still normal. It's always a good idea to look at prior labs, so the calcium from last year is helpful. If possible, it would be good to see any prior labs also. If his calcium was in the 9s throughout his 20s, but is now in the 10s, then that would be concerning for primary hyperparathyroidism. If his ...

Normal calcium Primary HPT Diagnosis

My endocrinologist suspects hyperparathyroid. She just did a blood test of PTH without calcium. It was 22. Is this a normal test and result? I had other labs showing calcium of 10.5 mg/dl and PTH 88 pg/ml. I am 65 years old.

The parathyroid hormone (PTH) level you mentioned (22 pg/ml) falls within the normal range, which is typically between 10 to 65 pg/ml. However, we cannot interpret PTH levels without calcium levels. A "normal range" PTH is only normal if the calcium level is also normal. The parathyroid glands produce PTH in order to regulate the amount of calcium in our blood. If your calcium level is low,...

Primary HPT Diagnosis Parathyroid Hormone (PTH)

Hi Dr. Boone, I am so grateful to have come across your website, it has brought me clarity and understanding in a subject very foreign to me. My question is, my sisters have MEN1, I have a genetic appointment in May for my testing. They all have hyperparathyroidism and have had surgery. My calcium level is 9.8 and my doctor said she corrected it due to albumin. My albumin was normal at 4.6 and my calcium was 9.8, this brought it to a 9.3. she tested my PTH at 43.7. She didn't test my vitamin D because she said she didn't feel she needed to. I have horrible bone pain too, but she said she didn't know that. She is sending me for a pituitary MRI due to high prolactin and vision problems. Why would she correct my CA if it didn't need to be corrected? Thank you so much!

Hello, I'm glad you've found the information on the website helpful. Firstly, it's important to understand that the "correction" your doctor is referring to is a mathematical adjustment based on your albumin level. Albumin is a protein in the blood that can bind to calcium, and a certain proportion of the calcium in your blood is typically bound to albumin. If your albumin level is abnormal...

Genetics Primary HPT Albumin Symptoms Diagnosis MEN1

I am 35 yr old female. Recently I just received a slightly elevated calcium result at 10.3 mg/dl. I opted to retest 2 days later, the level dropped to 9.6. Could the higher test be a fluke? The day of the test, I did not drink much water and the test was late in the afternoon. My retake was first thing in the morning with plenty of water. My previous levels are listed below: Oct 2022-9.5 Apr 2023- 9.0 Nov 2023-9.2 Feb 2024- 9.9 Mar 2024 - 10.3 Mar (2 days later) 2024- 9.6 Thanks so much for your input.

Single instances of elevated calcium can be flukes, but they can also indicate early parathyroid disease. It is certainly possible that your calcium of 10.3 was a fluke. Whenever I get a lab result that is surprising and different from prior results, I always like to repeat it to make sure it is accurate. If all prior and subsequent results were normal, with just one weird result in the middle,...

Normal calcium Hypercalcemia Diagnosis

I’m a 32 year old female. I have extreme fatigue and mood swings that are abnormal. It prompted me to ask my PCP for blood tests to try and determine cause. My vitamin D 25-hydroxy came back low at 12 ng/ml and my calcium at 10.4 mg/dl. My PCP prescribed me 50,000 iu of D3 once a week for 12 weeks and told me my calcium was low and to find a daily supplement with calcium in it. The more I read online about calcium and vitamin D, I feel like the root cause of my issues are related to parathyroid. I’m also concerned about the recommendation to take calcium when my mychart shows my calcium on the higher side of the bar chart.

Your concerns are valid and it's good that you're being proactive about your health. Your calcium level of 10.4 mg/dl is actually on the high side for your age, not low. In your early 30s, you can have calcium levels in the low 10s, but as you get older the calcium should start to go into the 9s. A high-normal calcium combined with a very low Vitamin D is concerning for primary hyperparathy...

Vitamin D Primary HPT Diagnosis Vitamin D deficiency

Hi I'm a 21 year old male my height is 6'1 and my calcium levels over last three months checked at an interval of 10-15 days have been: 10.5, 10.4, 10.0, 9.6 mg/dl.. I'm worried I might have hyperparathyroidism. My calcium levels hover between 9.6 and 10.5 whenever checked.

I understand your concerns. Calcium levels of 10.5 or 10.4 mg/dl is considered high for older adults, and so your lab may flag it as high on your results. At your age, though, it is normal to have calcium levels in the mid 10s. Most labs will adjust calcium ranges for children and won't bother adjusting with adults - but even adults in their 30s can still have calcium levels in the low 10s. Eve...

Hypercalcemia Diagnosis Primary HPT Normal calcium

I have a calcium of 11.1 mg/dl (age 55, female). We still need to order other labs. I have so many symptoms consistent with hyperparathyroidism. A lot of the reading I’ve done seems to say that they don’t do surgery under 12 as it “should” be asymptomatic. Can an 11 level cause symptoms?

Yes! A calcium of 11.1 mg/dl can definitely cause symptoms! I have had patients whose calcium levels never went above 10.5 mg/dl and they were absolutely miserable. The symptoms of primary hyperparathyroidism are unrelated to how high the calcium is. Any calcium above normal (above 10.0 mg/dl for a person over about age 40) can cause symptoms. Parathyroid disease is only rarely asymptomatic...

Parathyroid Disease Basics Symptoms Primary HPT Diagnosis

My PTH is high (118 pg/ml), but my calcium is normal at 9.6 mg/dl. My urine calcium 24hr is 207. What would this indicate? Normal? Way weird?

Thanks for asking! The short answer is that your labs are in a gray zone, so with just this information, it is not possible to make a definitive diagnosis. To figure out what is going on, I would need to get a thorough history and would want to see more labs. I'll go through my process here. There are two possible diagnoses that could explain your labs: 1. Normocalcemic primary hyperparathy...

Secondary HPT Diagnosis primary hyperparathyroidism Normal calcium

What makes my parathyroid level go up? My PTH is 91 pg/ml.

Since a "normal" PTH level is typically between 20 and 50 pg/ml, your parathyroid hormone level is definitely high. But we don't yet have enough information yet to know why. To figure out why your PTH level is high, we need to know your calcium level. Parathyroid glands are designed to respond to blood calcium levels. When the calcium level is low, they make more hormone (PTH) in order to b...

Secondary HPT Diagnosis Parathyroid Hormone (PTH)

I'm a 36 year old woman, and my calcium levels have been trending up for the last 4 years and my health has been in a rapid decline. I now have osteopenia. The fatigue and brain fog is so bad most days I can barely concentrate or function. My recent calcium was 10.5 mg/dl and I haven't had my PTH checked recently but last time it wasn't elevated. I am waiting for new lab orders. Before the increasing calcium the last few years I lived in the low 9s and that is where it seemed to stay (9.2-9.4 mg/dl) and looking at the trend it is now consistently high 9s with the highest being 10.5. I am terrified my health is going to keep declining. Do you do consults for people in my position?

Thank you for sharing your information. Your picture is definitely concerning for [primary hyperparathyroidism](https://https://www.southwestparathyroid.com/disease). A calcium of 10.5 mg/dl is a little high for your age. Sometimes people in their 30s can have calcium levels in the low 10s, which then drop into the 9s as you get above about 40 years old. But 10.5 is a little higher than what I ...

Parathyroid Disease Basics Symptoms Diagnosis Primary HPT

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 eva...

Hypercalcemia Diagnosis primary hyperparathyroidism

Hi Dr. Boone. I have recently been diagnosed with Vitamin D deficiency and have had a lot of symptoms. I am 34 years old and my Vit D level is 21 ng/ml, PTH 52 pg/ml, Calcium range from 9.8-10.2 mg/dl. Back in 2021 my Calcium level was 9 even. Is this a cause for concern or possibly just Vit D deficiency?

Hi, thanks for writing in. First, let's look at your calcium levels. A calcium of 10.2 mg/dl is on the high end for your age. When you are in your 30s, sometimes you can have normal calcium levels in the low 10s. As you get older, your levels will tend to drop into the 9s (mg/dl). After about age 40, most adults should have calcium levels in the mid to high 9s. Typically we see the calcium ...

Vitamin D Diagnosis Primary HPT Hypercalcemia Normal calcium

The local endocrinologist diagnosed me with primary hyperthyroidism. Ultrasound showed a 22 mm thyroid nodule. Should I have a FNA prior to having a surgical evaluation at your center? My calcium is 10.6 mg/dl and PTH 116 pg/ml.

Thyroid nodules are very common, especially as we get older. It is very common for thyroid nodules to be discovered on imaging for parathyroid disease. Do the nodules need to be biopsied prior to parathyroid surgery? It depends. I would want to see more information about the nodule before giving a recommendation. Most thyroid nodules are completely benign; some nodules will contain cancer. ...

Thyroid nodule Primary HPT Diagnosis Operation Treatment

I had a recent CT scan of parathyroid that was reported normal. I was put on low calcium diet for next 2 months then repeat tests. Can CTs be false negative & can diet change results and help confirm need for surgery or is it a waste of time? Seems surgery is needed now? Thank you from Ontario, Canada. Calcium is 2.83 mmol/L (11.3 mg/dl) and PTH 14.2 pmol/L (134 pg/ml). I am 68 years old.

First, these labs very clearly indicate primary hyperparathyroidism, since the calcium and PTH are both far outside normal range. We don't need anything else to make the diagnosis. A low calcium diet is not going to change this diagnosis. Your calcium and PTH levels may both fluctuate to some extent, since that happens with primary hyperparathyroidism, but the diagnosis will not change. ...

Diagnosis Hypercalcemia Primary HPT Parathyroid Disease Basics Imaging

I have both high pth (140) and high calcium (10.4). A Scan of my parathyroid glands showed normal. What should I do to lower these?

Thanks for writing. Your scenario is fairly common. Your labs are classic for primary hyperparathyroidism (high calcium and high PTH), but your parathyroid scans are negative (no parathyroid tumors seen). So what should you do to lower the calcium and PTH? **Short answer: A parathyroid operation.** Long answer: Parathyroid surgery is the only way to cure primary hyperparathyroidism. ...

primary hyperparathyroidism Diagnosis Treatment Parathyroid Disease Basics Imaging

We are concerned that I have primary hyperparathyroidism. My calcium levels have been moderately high since 2019. I also began having high blood pressure, vitamin D deficiency, and became diabetic around the same time. I am 52 and since July of this year, my calcium has been 10.9, 11.6, and 10.9 mg/dl. The last two readings were two days apart and my doctor ordered tests for ionized calcium (5.5, but at the highest point of normal) and PTH intact as well. PTH was 33 pg/ml. Vitamin D 25-OH is 32 ng/ml. Many things I read comment on high PTH levels or low, but this confuses me. I have taken my total exhaustion for the last few years as just the 5 kids, but I have literally almost no energy whatsoever and I started having migraines in July pretty regularly. Is my gut feeling that it requires surgery the right way to go? I ask, because my doctor never said anything about my calcium levels over the last few years and it has been 10.4 or higher since 2019. It was only after it hit 11 that she wanted me to take extra tests.

Thanks for writing. Based on your calcium levels, I am also concerned about primary hyperparathyroidism. High calcium levels are not normal, and the most common cause of persistently elevated calcium is primary hyperparathyroidism. Your calcium has been elevated since at least 2019, based on what you have said. A calcium level of 10.4 mg/dl is not normal for adults over age 40. If your calc...

Primary HPT Diagnosis Parathyroid Hormone (PTH) Hypercalcemia

Hello! Thank you for your time! My 22-year-old daughter has had the following calcium levels over the past year: 10.0, 10.4, 9.9, 10.0 and 10.3 mg/dl. She is taking 5000u vitamin D and her last check of Vit d 25-OH level was 60 ng/ml. She has Hashimoto's and takes armour. Her albumin stays around 4.9. Is there any need for concern or need to test her PTH level? Thanks so much!

Thanks for asking. At her age, these calcium levels are within normal range. Teenagers and young adults can have calcium levels in the low to mid 10s (mg/dl). This is just normal at that age. Over time, the calcium levels will tend to drop into the 9s and stay there, usually by around age 40. Her levels are fluctuating a bit into the higher end of normal for her, and I suspect this is d...

Vitamin D Diagnosis Normal calcium