thyroid_parathyroidWe as thyroid patients spend so much time talking about the thyroid gland that many aren’t aware of four other little glands that share neighboring space with your thyroid–your PARATHYROID glands.

Also, if you react badly to Vitamin D, this is a page you need to read. 

Parathyroid glands are teeny – close to the size of a very small bean or a grain of rice. There are usually two on each side of your thyroid. Those higher ones are caller superior parathyroid glands, and the lower ones are called inferior parathyroid glands.

What are our parathyroid glands for?

Even as tiny as these glands are, they play a big role in your health and well-being by being the master regulator of of the hormone and macronutrient calcium in your body via the parathyroid hormone (PTH). i.e. your parathyroid glands will make sure you have enough, or not too much, of calcium by either releasing the PTH hormone, or not releasing it. This will go on all day to maintain that delicate balance of “enough”.

You have more calcium in your body than any other mineral, and it’s mostly stored in your bones and teeth–up to 99% of it say a lot of sources. So it plays a key role in keeping both strong and thick. It can also be found in your tissues and blood.

Calcium aids in the following:

  • the contraction of your muscles,
  • the relaxation of your blood vessels
  • the release of signaling by your neurotransmitters
  • optimal nervous system functioning
  • adequate blood clotting
  • the secretion of insulin
  • your heart’s health
  • optimizing the job of your body’s enzymes and proteins
  • helping Vitamin D to convert to calcitriol (the active form of D) in your kidneys
  • maintenance of your magnesium levels

What is the most common way our parathyroid glands can go haywire?

Contrary to the majority of thyroid patients having HYPOthyroid, the most common parathyroid problem is HYPERparathyroidism , of which there are two main kinds:

  1. Primary hyperparathyroidism (pHPT):  Unfortunately for some, one or more of those glands can decide to become a bit hyper, increasing in size like a tumor, to produce too much PTH, and cause your body’s blood calcium levels to go too high. What causes it? There’s no definitive answer for many patients who discover they have this issue! But for other causes, there is suspicion that it can also be related to taking lithium or steroids.  When all four glands are enlarged and hyper, this is called parathyroid hyperplasia.
  2. Secondary hyperparathyroidism:  This form can occur simply from your calcium levels going too low due to kidney disease/renal problems, which in turn causes the parathyroids to overproduce. Pancreatitis and small bowel disease can spur secondary hyperparathyroidism, as well.

How do labs help me figure out if I have hyperparathyroidism (pHPT)?

Three tests will help: Total serum calcium, ionized calcium, and intact PTH.

If either calcium level is high and the PTH high (and that includes even moderately high), you’ve got a problem! Even if your PTH is “normal”, and your calcium is high, you may have hyperparathyroidism (pHPT).

Even if it’s in the normal range, someone can have pHPT.  There needs to be a proportionate balance between the two levels. For instance:

Calcium 10.0 (8.7-10.2)
PTH 60 (15-65)

This person could still have pHPT, even though they’re disproportionate, and the PTH should be closer to 20. If calcium is 9.3 (8.7-10.2) and the pth is 43 (15-65), this would be a more accurate “normal” lab result that doesn’t indicate any issues.

There is also another recently recognized state called Normocalcemic Primary Hyperparathyroidism. It is when the blood parathyroid hormone (PTH) levels are higher than normal, but the blood calcium level is normal in patients who do not have secondary hyperparathyroidism disease. Patients can have blood calcium levels that are occasionally high. Many patients with Normocalcemic pHPT will go on to develop classic pHPT. However, not all patients will go on to develop classic pHPT, and in fact some never progress at all. This is mentioned here.

Phosphorus can go too high as well in some with hyperparathyroid. Others may have low levels, tho.

Note that if you are over 40, you shouldn’t see calcium levels higher than 10.

Here’s another way to evaluate your results.

What are symptoms of having hyperparathyroid?

Nearly everyone with this disease has symptoms, and you can have four or more of the following, or all of them. But since several below could be associated with hypothyroidism, it’s wise to also do the PTH and calcium lab test to confirm which symptoms go with what!

  • pain in your joints or bones (causing you to be diagnosed with “fibromyalgia”)
  • headaches
  • heart palpitations or fast heartrate
  • brain fog, depression, lack of concentration, memories issues
  • nervousness, irritability
  • fatigue (a very common symptom, and you may get diagnosed with Chronic Fatigue Syndrome when you actually have HPT)
  • loss of energy
  • sleep problems
  • cramping in your muscles
  • kidney stones
  • acid reflux
  • Osteopenia or Osteoporosis
  • labs which show a stressed liver
  • stroke
  • rising blood pressure (common)
  • low levels of Vitamin D
  • strange reactions when you take Vit. D, such as heart racing and anxiety

What is done to treat hyperparathyroid?

Surgery is the only cure. There are several types: Bilateral Neck Exploration, Minimally invasive parathyroidectomy (MIP), and Minimially Invasive Radioguided Parathyroid (MIRP) surgery, to name a few. There are many ways in how parathyroid surgery is performed based on surgeon preference. When deciding on a surgeon, it’s important to remember that the type of technique used is far less important than the surgeon’s personal experience and success rate. Research has proven that the chance of being cured and of not having a complication after parathyroid surgery depends on the experience of the surgeon. Depending on how complex the situation, the operation may last as little as 20 minutes or as long as several hours.

But…here’s an article who says that Vitamin D supplementation can help lower high levels of PTH: https://www.vitamindcouncil.org/blog/vitamin-d-supplementation-in-primary-hyperparathyroidism-not-a-bad-idea/

What about HYPOparathyroidism (hPTH)?

This unfortunate and more rare outcome–when one has sluggish or no Parathyroid hormone (PTH)–is mostly caused by damage to the parathyroid during thyroid surgery or the use of RAI–radioactive iodine in the treatment of Grave’s disease or Thyroid Cancer. One will see calcium fall and phosphorus rise. Low magnesium can also cause a healthy parathyroid to produce less PTH, as can a body which has become too alkaline (the opposite of acidic), called alkalosis. The latter can be caused by hyperventilation or the excess of of bicarbonate (baking soda). 

Symptoms that one of more your parathyroid is underproducing include:

  • muscle spasms or cramps
  • numbness in your face or hands
  • tinging in fingers, toes or lips
  • weakness, fatigue
  • brittle fingernails
  • dry hair; dry skin
  • increased pain
  • headaches
  • sleep issues
  • depression, poor memory
  • anxiety, nervousness, irritability
  • heart issues
  • seizures

Treatment of hPTH includes supplementation with calcium and vitamin D, as well as avoiding phosphorus in foods.

What role does Vitamin D play in all this?

Vitamin D, along with the PTH, helps to increase your blood levels of calcium by promoting absorption of calcium from your small intestines and stomach. i.e calcium won’t be absorbed without that Vitamin D! But if your parathyroid becomes hyper, your Vitamin D can fall. So if you also have hypothyroidism, which also results in lowered Vitamin D levels due to low stomach acid, your Vit. D levels take a huge hit.

 

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*Read Barbara’s story of finding out she had a parathyroid problem

*Read Wendy’s comments after having parathyroid surgery.

Here are photos of enlarged parathyroid glands, called adenomas.

* A great site to learn more is from the Norman Parathyroid Center.

* UCLA’s long distance surgery program information here.

* Have a parathyroid story to share? Use the Contact form below to send it to STTM.

Thanks to parathyroid patient Wendy for providing extra information to this page!!

How to Choose a Parathyroid Surgeon: https://www.youtube.com/watch?v=BLLZ5FynWCw