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Vitamin D

Vitamin D is intimately involved in calcium absorption and regulation, along with PTH. Vitamin D levels are often helpful in diagnosing parathyroid disease.

Do I need to take Vitamin D? My latest calcium was 10.7 mg/dl and PTH 60 pg/ml. My doctor is very concerned about my Vitamin D of 15 ng/ml, and says that I should get my Vitamin D level up with supplementation before undergoing parathyroid surgery. Someone else said I should not take Vitamin D. Should I take it? (I am 50 years old.)

This question comes up a lot with parathyroid patients! Most patients with primary hyperparathyroidism will have low or low-normal Vitamin D levels. And many of them are told to take Vitamin D supplements. I do not recommend doing this, and I'll explain why. Your labs indicate primary hyperparathyroidism because your calcium is elevated and the PTH is inappropriate for that calcium. When yo...

Vitamin D Vitamin D deficiency Parathyroid Disease Basics primary hyperparathyroidism

Will I need to take medications after parathyroid surgery?

After surgery, you will need two things, which are over-the-counter: 1. Calcium and Vitamin D 2. Pain control Most patients will not need any prescription medications after surgery. I generally recommend over-the-counter medications for pain control, such as ibuprofen (Motrin, Advil) and acetaminophen (Tylenol). Narcotics have side effects and are usually not more effective than the over-...

Postop expectations Vitamin D

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'm in my early 50s. My calcium has fluctuated between 10.1 and 10.5 over the past two years. My PTH was high normal until this past winter. Now it's above normal in the 90s. My vitamin D has stayed around 29. I am delaying surgery due to Covid and finances. My endocrinologist told me to take 2000 IU of vitamin D daily to lower my PTH. Does supplementing with vitamin D lower PTH and is it safe with hyperparathyroidism? I do know that when I've taken D I feel very tired the next day.

You should not take Vitamin D supplements if your calcium level is high. I'll explain why below. Primary hyperparathyroidism (pHPT) very often causes Vitamin D deficiency, and so it is common for patients to be told to take Vitamin D supplements. Unfortunately, if you have a parathyroid tumor, taking Vitamin D is not going to help, and may hurt. One of the main roles for Vitamin D in your b...

Hello Dr. Boone, I have low vitamin D 25 (19), high vitamins D 1-25 (79), high end of normal calcium (high 9’s), and PTH typically in the high 40’s (same blood draw). I am a 42 years old. I also have calcium phosphate kidney stones. However, due to all of my labs being “normal” other than vitamin D, I have been told I do not have hyperparathyroidism. Can low vitamin D mask the disease? Vit. D supplements make me terribly sick from and I develop stroke symptoms when taking. Therefore, I stopped taking the recommended vitamin D. Without taking the vit d I feel significantly better. Any help is appreciated. Thank you.

Thanks for writing. Low Vitamin D levels are associated with primary hyperparathyroidism, but do not diagnose it. The diagnosis of primary hyperparathyroidism relies mostly on calcium and PTH levels. Sometimes Vitamin D levels can help support the diagnosis (or point away from it). But with calcium and PTH levels in the true normal range, Vitamin D does not play a big role in the diagnosis of p...

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

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

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

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 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

Hi! Is there any food you have to avoid if you have high calcium and high parathyroid levels?

Thanks for asking! Patients are often told to avoid high-calcium foods like dairy products when they are diagnosed with primary hyperparathyroidism. But in most cases, this isn't really necessary (unless you are eating absolutely insane amounts of dairy, which is not good for you anyway!). If you have primary hyperparathyroidism, your calcium is high because you have an overactive parathyro...

Hypercalcemia Parathyroid Disease Basics Primary HPT Vitamin D

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