from the Experts at the Norman Parathyroid Center
Interesting stories of hyperparathyroidism we see every day. Parathyroid blog published bi-weekly.
High blood calcium levels are almost never normal and increases the chances of developing a number of other health problems and even early death if ignored. For adults over 35 years of age, this means we should not have blood calcium higher than 10.0 mg/dl (2.5 mmol/l). High blood calcium due to hyperparathyroidism occurs in 1% of women over 50, and one in 200 men, yet a lot of doctors aren’t paying attention to this problem. High blood cholesterol, on the other hand, is much more common (one in 6 Americans). We have all known for many years that we need to keep our cholesterol into the normal range, and for many of us that means taking a “statin” type of drug. Why does everybody know about the risks of high cholesterol while the risks of high calcium are often ignored even though high calcium is considerably more dangerous? Could it be that the big drug companies have educated us about high cholesterol, but since there is no drug for high calcium nobody has bothered to teach us? Well, let’s learn this today, and then let’s print the references at the bottom of this parathyroid blog and teach our doctors!
High cholesterol: A problem without symptoms. High cholesterol doesn’t worry some people because:
High Calcium: A problem with symptoms. In contrast to high cholesterol that doesn’t have any symptoms, high blood calcium and high parathyroid hormone is almost always associated with symptoms–typically at least 4 of the following:
Thus both high calcium and high cholesterol are dangerous, but high calcium (even a little bit high) is much more dangerous than high cholesterol, and the high calcium makes you feel bad. Why are we ignoring high calcium? Why do half of doctors know so little about the risks of high calcium.
It is very important to understand that the health risks from high cholesterol AND the risks high calcium aren’t immediate. The damage accumulates over years — even decades. Because the effects take time, some people may not feel the urgency to treat it. You may think you can deal with it later – but you may wait too long. This delay in treatment is a major problem with doctors who don’t know much about primary hyperparathyroidism (including a lot of endocrinologists). We hear doctors tell their patients all the time: “your calcium is little high… let’s keep an eye on it and watch it for a while to see if it goes higher”. This is like saying “Your cholesterol is high, let’s watch it for a while”. Better yet, it’s like saying “your house is on fire, but it’s a small fire… so let’s keep an eye on it for a while”. We know that many years of high cholesterol will decrease your life expectancy because of the higher chance of heart attack and stroke. HOWEVER, the risks of high blood calcium and the risks of hyperparathyroidism are at least twice that of high cholesterol (probably about 4 times higher risk) because the high calcium doesn’t just cause an increase in the rate of heart attack and stroke, it also increases the risk of several cancers (breast, prostate, colon, kidney), and increases the risk of kidney failure, high blood pressure, cardiomyopathy (poor ejection of heart blood), atrial fibrillation and heart arrhythmias, and bone marrow failure (with low platelets, MGUS, low red cells, and low white cells) and a host of other problems outlined in our reference section below. Please read the reference list at the bottom of this article for published research articles on the risks of hyperparathyroidism and the risks of prolonged elevations of high blood calcium.
Thus, the approach by doctors that say “the calcium is not that high, let’s watch if for now” is not based in science (outlined below) and what we know about long-term high blood calcium risks. Having high calcium, just like having high cholesterol may not hurt you today or tomorrow, but if you don’t do something about it, it can have a terrible cost down the road. We have taken care of nearly 25,000 patients with hyperparathyroidism and high blood calcium, and we can’t remember ever seeing somebody with this disease for 25 years–they are all deceased from the list of complications above. When we see patients with high blood calcium for 15 years, almost all of them have decreased kidney function (see our blog on this), severe osteoporosis, are on 3 or more blood pressure medications, and have had to quit work because they can’t concentrate and are so tired all the time. When we see patients with high blood calcium for 20 years, at least half of them are using a walker because they are too weak to walk any distance, and almost all of them are in atrial fibrillation with over half having a pacemaker. Prolonged high calcium, even a ‘little bit high” for years will absolutely, in EVERY case, cause multiple organs to fail. We see this every single day.
High blood cholesterol itself does not cause symptoms, so many people are unaware that their cholesterol level is too high. Likewise, some people with calcium levels “just a little bit elevated” have no symptoms, while others have terrible fatigue. Many doctors will say that a lot of patients with hyperparathyroidism are “asymptomatic” (without symptoms) because they are not counting the fatigue, GERD, memory loss, high blood pressure and osteoporosis. They are only counting the “old-time” definition of hyperparathyroid symptoms which are kidney stones and spine / hip fractures. Because of the many studies performed in the past 2 decades (some of which are listed below), we now have overwhelming evidence that virtually all patients with high blood calcium and hyperparathyroidism have symptoms, and those uncommon “asymptomatic” patients (no symptoms) will develop symptoms if the calcium is not decreased by removing the parathyroid tumor. As you will see from reading the list of articles below and their conclusions, 10 or more years of even slightly high calcium will increase a persons risk for heart attack, stroke, heart muscle failure, cardiomyopathy, kidney failure, carotid artery thickening, aorta calcification, and more… Ten years of high calcium is more dangerous than 20 years of high cholesterol.
High cholesterol requires taking cholesterol-reducing drugs daily for decades to have an impact on a person’s risk of heart attack. Every day, tens of millions of people take some form of “statin” drug, in hopes of decreasing their high cholesterol levels. People in their 40’s and 50’s take these drugs for decades in hopes of delaying a heart attack while in their 60’s and 70’s.
High blood calcium due to hyperparathyroidism carries greater risks for the development of multiple medical problems leading to early death when compared to high cholesterol, but it is very different in that hyperparathyroidism can be cured in virtually all people in less than 20 minutes. We cure over 50 people per week by removing their parathyroid tumor, sending them home an hour or so later. Sure, everybody cannot come to Florida to have surgery, but you must find an expert parathyroid surgeon and have the parathyroid tumor removed. In contrast to taking drugs for high cholesterol, the health benefits from getting the parathyroid tumor removed are immediate–they are not delayed 20 or 30 years down the road. When the parathyroid tumor is removed and the hyperparathyroidism (and high calcium) are cured, the risk for breast cancer decreases within a year or two; the risk for kidney stones and kidney failure decrease dramatically within hours; the blood flow through the coronary arteries increases within weeks; cardiac muscle contraction increases within weeks; the risk of bone fractures decreases within months; and on and on. The list below is a very small sample of the research showing these risks and their improvements following successful parathyroid surgery.
We have treated over 25,000 patients with primary hyperparathyroidism, now performing an average of 52 parathyroid operations weekly on patients from all over the world. We see these patients treated by some doctors who understand the risks of high calcium and demand that the patient have the parathyroid tumor removed at the very first high blood calcium. However, every day we see patients treated by doctors who have no clue about the high risks of “watching” the high blood calcium, thinking that “since the calcium is not that high, we can just keep checking it to see if it goes higher”. Hopefully the reader of this article knows this: How high the calcium has become is irrelevant — the height of calcium is a very poor indicator of the severity of parathyroid disease. The complications, health problems, and death due to high blood calcium are related to the length of time the calcium has been high–just like it is with high cholesterol. How long, not how high!
It takes 20 minutes (often less!) to cure almost all patients of hyperparathyroidism, leading to tremendous health benefits for the rest of your life. As discussed in another blog, your surgeon should look at all four parathyroid glands because 30% of people will have more than one bad parathyroid gland. Leaving one small, overactive parathyroid gland in your neck (even after taking out a large tumor) will not provide the health benefits you are looking for and expecting, thus all four parathyroid glands should be examined. If your surgeon wants to take out the one tumor that shows on the scan and not look at the other three parathyroid glands, then you may want to find a more expert surgeon–after all, you want one operation to put this disease (and it’s risks!) behind you forever!
Please look closely at the TWO sections below. The first is a list of conclusions that come directly from the medical journal publications listed in the second section. Each article (in the second section) has a link directly to the medical journal article. Print this reference list to take to your doctor. Heck, print this entire page (and then don’t leave their office until they read it!).
IMPORTANT CONCLUSIONS FROM THE SCIENTIFIC ARTICLES (bottom of page) REGARDING THE RISKS OF HYPERPARATHYROIDISM.
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James (Jim) Norman, MD, FACS, FACE, is recognized as one of the world's foremost expert on parathyroid disease and hyperparathyroidism and has treated far more parathyroid patients than any other doctor in the world. He is the founder of the Norman Parathyroid Center in Tampa, Florida, the world's leading center for the diagnosis and treatment of hyperparathyroidism. Dr Norman has made numerous contributions to to the understanding of parathyroid disease and is credited with dramatically changing the way parathyroid surgery is performed. He is a fellow of the American College of Surgeons (FACS) and also a Fellow of the American College of Endocrinology (FACE). He is recognized in the top 1% of all surgeons by US News and World Reports in addition to dozens of other awards and Best Surgeon accolades. He has published over 250 peer-reviewed journal articles. Dr Norman and his partners perform more than 3,300 parathyroid operations annually on patients from all over the world.