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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> It depends on what your actual calcium levels are. <strong>Sometimes what is called "high-normal" is actually too high. </strong> Adults over about age 40 will generally have calcium levels at or below 10.0 mg/dl (or 2.5 mmol/L). If it is persistently above that, then your calcium levels are high, not high-normal. (If you are under 40 years old, then you can have calcium levels that are sl...

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 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

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

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...