Hyperparathyroidism Blog 

from the Experts at the Norman Parathyroid Center

Interesting stories of hyperparathyroidism we see every day.  Parathyroid blog published bi-weekly.

High Blood Calcium: How Long, not How High!

High Blood Calcium: How Long, not How High!

High blood calcium is almost never normal, and it makes people feel miserable! It is the duration of high calcium, not the actual number!

Lisa is a 57-year-old lady from Ohio with primary hyperparathyroidism. She has seen her primary care doctor for several years and is always noted to have high blood calcium levels, but they are “just a little bit high.” Her blood calcium level is just above the normal range of the laboratory (which does not adjust for age, by the way). Her blood calcium has ranged from 10.2 to 10.6 (mg/dl). This has been the story for the last four years as she continually complains of being tired, depressed, achy, and has trouble concentrating and sleeping.

Her family practice doctor placed her on a few medications–to help her sleep and to elevate her mood–and said, “You have high blood calcium, but let’s just watch it for now. It’s not that high. It is barely elevated. Back in a year for more bloodwork!” Lisa took to the web and decided to look into “high blood calcium levels.” She was ultimately diagnosed with primary hyperparathyroidism after she got a new primary care doctor and had her parathyroid hormone level measured. It was 93. It was repeated and was 97.

She self-referred to our Parathyroid Center, where we explained some of the things her first PCP perhaps wasn’t aware of. People don’t live with calcium levels “in the 10s,” no matter what the lab’s normal range is. High blood calcium is just not normal. Organs like the brain, bones, heart and blood vessels, and kidneys are affected by the duration of the high blood calcium more than the actual height of the calcium.. She was cured of this disease within three hours of our meeting her. Lisa had a large parathyroid tumor, and she was found to have three normal remaining parathyroid glands (see photo).

High blood calcium is almost always caused by parathyroid tumors.

This parathyroid tumor caused Lisa’s high blood calcium.

She headed off to her home in Ohio (minus 1 parathyroid adenoma!) with a sunny future ahead of her, free of this disease.

Parathyroid disease is unique from just about any other disease. Most diseases that we encounter in medicine allow some objective test to be measured in order to correlate how severe the disease is. Think about it: heart disease has cholesterol and triglyceride levels to monitor. The higher the number, the worse the disease, right? Logically, it follows that cholesterol levels of 298 signify coronary artery disease that is worse than cholesterol levels of 119. Diabetes fits the same description. The higher the blood glucose level, the worse your diabetes and the better chance that you will develop the complications of diabetes that involve the kidneys, heart and blood vessels, eyes, etc. Hypertension can be categorized in the same way. Blood pressure readings of 198/122 are cause for alarm! Numbers like this equate to much worse hypertension and much more need for medical control than blood pressures of 133/89. It seems rational that parathyroid disease follows suit. We figured out several years back that this just isn’t the case. High blood calcium that is really high is not necessarily more “significant” than high blood calcuim which is just a little bit high. Parathyroid disease is different in that Lisa’s calcium levels between 10.2 and 10.6 are as impressive as they are likely to ever get. If you follow Lisa’s case for years (and her family practice doctor did!), you will find the same blood calcium number as you saw years before. It is unlikely that calcium levels of 10.3 or 10.4 are going to dramatically jump up to 12.8 or 12.9, which would surely get the attention of her doctor. The chances of that happening are statistically in the single digits.

High blood calcium: how long it is elevated...that's the key!

High blood calcium causes damage by the duration of its elevation, not by the actual number that is measured on a given day.

It is the time spent with calcium levels above 10 that dictates the severity of primary hyperparathyroidism, not the degree to which the calcium is elevated. In fact we have found that patients complain of a larger number of symptoms when they have blood calcium levels in the 10′s than if their calcium level exceeds 12. Thus our mantra of “how long is more important than how high.”

If you want to know how bad parathyroid disease is, then you should follow the calendar, not the calcium!

Lisa is checking her calendar far more frequently now: to plan all of the projects she has in store for her husband, Jeff. He’s still not speaking to us!

 

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About Dr. Douglas Politz

Dr. Douglas Politz

Dr. Doug Politz is one of the world's most knowledgeable parathyroid doctors and the second most experienced parathyroid surgeon in the world. Dr. Politz attended LSU Medical School where he graduated with the Chancellor’s Award as the Most Outstanding Graduate. Dr. Politz obtained his surgical training at the University of South Florida in Tampa, working with Dr. Norman for 5 years. Doug is a member of over a dozen surgical societies and is a fellow of the American College of Surgeons (FACS) and the American College of Endocrinology (FACE). He has been awarded the "Patients Choice Award" 8 consecutive years (top 3% of all American doctors), has been named one of America's Top Surgeons annually for over a decade. Dr. Politz has been a senior surgeon at the Norman Parathyroid Center since 2005 and has dedicated his surgical career to the treatment of hyperparathyroidism.

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