For $5.99 you can figure all of this out
yourself. The very cool app will graph all of your tests, tell you
what is going on, and what to do about it. Get the Calcium-Pro
app! For iphone/iPad,
Read our Parathyroid Blog!
Our doctors write interesting stories about patients we see
every day. This is the coolest thing we do!
do we diagnose hyperparathyroidism (parathyroid disease) when most
people have never heard of a parathyroid gland until their doctor tells
them that they have a problem with one of their parathyroids? The typical
response is "Doc, what is a parathyroid gland? I've never heard of a
parathyroid or parathyroid gland. How can we diagnose this to be sure that I really have parathyroid disease and
how can we be sure this bad parathyroid gland is causing me a problem?"
"Hey doc, are you talking about the thyroid?? Or the parathyroid? What is
a parathyroid? What does it mean to have a high calcium level in my blood?
How can I have a tumor in my parathyroid gland when I've never heard of a
parathyroid gland!?" If you can read and understand this ONE page,
you will know more about parathyroid disease than 90% of doctors.
Better yet, download our CalciumPro
app so you can put your test results on all of these graphs and the
app will tell you if you have a parathyroid tumor and what your risks are.
If you are reading this page, you must get the app!
Everybody has 4 parathyroid glands, and sometimes one or more of them
goes bad. We discuss the symptoms of parathyroid disease on a different
page (click here for symptoms).
On this page we discuss how to make the diagnosis of parathyroid disease
and how to know for sure if you have a parathyroid problem that needs to
The Basics of
Diagnosing Parathyroid Disease (Hyperparathyroidism)
Since parathyroid glands are glands
within the endocrine system, we can detect
parathyroid disease by measuring the hormone that the parathyroid
make and compare this level to the amount of calcium in the blood.
All endocrine glands make hormones, and all hormones have a
"normal" level in our blood. If an endocrine gland
develops into a tumor, it will over-produce its hormone. The
hormone has effects on other parts of the body (that's what
hormones do!). In the case of a parathyroid gland tumor, it
overproduces PTH which in turns takes calcium out of the bones and
puts it into the blood. It is the high calcium in the blood that
makes us sick!
glands make parathyroid hormone.|
hormone controls calcium in the blood.|
is a normal range for parathyroid hormone in the blood.|
the blood calcium level is too HIGH, it should be associated with a
LOW parathyroid hormone level--if the parathyroids are normal...
(a normal parathyroid will shut down and go to sleep if the
calcium level is high).|
blood calcium level that is too HIGH, and is associated with a
HIGH parathyroid hormone level MUST be due to a tumor in the
parathyroid gland. That is, the high blood calcium is a result of
the excess parathyroid hormone (PTH). It is the parathyroid gland
that is the problem.|
A person with a high blood calcium that has a high parathyroid
hormone level at the same time--must have a bad parathyroid gland.
These are the EASY cases of hyperparathyroidism to diagnose. All
doctors should be able to make the diagnosis of
hyperparathyroidism if the calcium is high AND the PTH level is
high at the same time.
However... many people (about 20% of all
patients with hyperparathyroidism) will have parathyroid disease
when they have high calcium and NORMAL PTH levels... The point
here is that the parathyroid gland is still the problem. This is a
more complex situation, so we will discuss it at the end of this
page. Let's keep it simple now... high calcium + high PTH =
parathyroid tumor. If you really want to make it simple, if the
blood calcium is high, then there is over 99% chance that a
parathyroid gland has grown into a tumor.
must be diagnosed with
parathyroid disease (hyperparathyroidism) if your parathyroid hormone level is high and your
calcium level is also high. The excess parathyroid hormone is the CAUSE of
the high calcium. The high calcium is caused by a parathyroid tumor--nothing else will
Under normal conditions, a normal calcium level will be associated with a normal parathyroid hormone level. Also under normal conditions, a low serum calcium level will be associated with a high parathyroid hormone level; and a high calcium level will be associated a with low parathyroid hormone level. These are all appropriate ways in which a parathyroid gland will react to calcium which is circulating in the blood as the parathyroid glands attempt to regulate calcium in the narrow "normal" range.
More detail about the normal function of parathyroid glands is covered on our "function" page.
However, it is extremely rare for people to have high calcium levels in
their blood... and not have a parathyroid tumor. If you have high calcium
in your blood, chances are extremely high you have hyperparathyroidism,
unless your PTH is VERY LOW. Parathyroid disease,
hyperparathyroidism, calcium, parathyroid calcium disease, parathyroid
gland problem. Parathyroid problem and parathyroid disease.
is NORMAL for patients with hyperparathyroidism (parathyroid disease) to
have calcium levels that are high one time it is checked, and normal the
next time it is checked. ALL patients with hyperparathyroidism will have
calcium levels that change from day to day, week to week, month to month.
MOST patients with hyperparathyroidism have
calcium levels that FLUCTUATE from high to slightly high, to
high-normal. This does NOT mean that you don't have the
disease...you do, and this is how it affects most people.
Fluctuating levels of calcium is one of the '10
Parathyroid Rules of Norman'. One mistake that is often made by
physicians who don't see much of this disease (it is pretty rare), is that
they will measure the calcium repeatedly to see if it is "staying the
same" or "slowly trending up" over time. They (and you) can
get a false sense of security when you see that your calcium is only
slightly elevated and not getting any worse over time. This is one
of the basic BAD assumptions you can make with parathyroid gland
disease. Remember, once you have this disease, it will not get better on
its own. Furthermore, it will always get worse...slowly perhaps, but it
will get worse. Read more of this web site to understand this basic
principle. Something else to keep in mind, the calcium in your blood and
in your urine is coming from somewhere--your bones! If you haven't looked
at our page of pictures of parathyroid
tumors you need to do so.... look at the tumors we have removed from
patient's necks and compare their calcium levels to yours. Parathyroid disease, calcium, parathyroid calcium disease, parathyroid
Parathyroid problem and parathyroid disease.
(over-activity of the parathyroid gland) is relatively easy to detect because the parathyroid glands will be making an inappropriately large amount of parathyroid hormone in the face of an elevated serum calcium. This is straightforward and simple to measure. Another way to confirm this diagnosis is by measuring the amount of calcium in the urine over a 24-hour period of
time. (note: this is not done very often any more, and typically is done only if
the patient's calcium and/or parathyroid hormone levels are only a little
out of the normal range and the doctor wants to really be sure of the
diagnosis). If the kidneys are functioning normally they will filter much of this calcium in an attempt to rid the body of calcium leading to an
abnormally large amount of calcium in the urine. Measuring calcium in the urine, however, is an indirect measure of parathyroid activity and is only accurate in about 25 to 40 percent of the
time (in other words, MANY patients with hyperparathyroidism will have
NORMAL amounts of calcium in their urine--so having a normal urine calcium
test does NOT mean you don't have hyperparathyroidism). The most accurate and definitive way to diagnose primary hyperparathyroidism
(disease of the parathyroid glands) is by showing an elevated parathyroid hormone level
at the same time you have elevated serum
doctors do not know how to diagnose parathyroid problems and
parathyroid disease is found because your doctor checked your blood for
abnormalities and found the calcium level was too high. Typically, the
doctor will repeat the calcium to see if it really is high, or if it was
just a 'lab error'. If the calcium is high again, the doctor will order a
parathyroid hormone level to be checked. If the parathyroid hormone comes
back elevated...that's it... you have parathyroid disease
(hyperparathyroidism). If the PTH level is "normal"... that's
it, you still have hyperparathyroidism.. YES. High calcium and ANY PTH
LEVEL that is not very low means you have hyperparathyroidism. This is
a very important sentence! Many of you will need to print this page and
take it to your doctor so you can show him or her this sentence. And then,
print one of our pictures of
parathyroid tumors and show it to your doctor too... and show that
these tumors come from patients with high calcium levels and
"normal" PTH levels. Geeezzz, it breaks our hearts every
day to see the number of people who are feeling poorly because of
parathyroid disease who aren't being treated correctly because their
doctor doesn't know much about parathyroid disease... and won't go through
the trouble of looking it up on the Internet, or making a phone call to
another doctor who knows. MANY patients with large parathyroid tumors have
high calcium levels and NORMAL PTH levels... THIS IS STILL
HYPERPARATHYROIDISM, AND THIS STILL MUST BE FIXED! We operate because the
CALCIUM is high, regardless of the PTH level! Keep reading!
The chart below shows examples of patient's
calcium levels, PTH levels, and whether or not they have
hyperparathyroidism and whether or not they need surgery to remove a
parathyroid tumor. These are just some examples, and there are a few
more different variations... but these are the most common presentations
of parathyroid disease, representing at least 99% of all patients with
Who has Hyperparathyroidism?
Normal 8.5 to 10.4
Normal 10 to 65
||Needs an Operation?
||Yes (if over
||9.8 - 10.2
Patients 1 through 6 are very routine patients with
hyperparathyroidism. The diagnosis of hyperparathyroidism should be made
by most/all doctors. It's simple, these people have a parathyroid tumor
that is making too much parathyroid hormone which makes the calcium go too
high in the blood. These patients do not need any more testing. They don't
need to measure calcium in the urine, and they don't need any x-rays or
scans. They need to find an expert surgeon and have their parathyroid
tumor removed. Patients 7 and 8 also have hyperparathyroidism and they
also have a parathyroid tumor making too much hormone. These patients are
more difficult for the average doctor to diagnose, because the doctor will
say "it can't be hyperparathyroidism because your PTH level is normal".
This is a very serious mistake. If the parathyroid glands were
NORMAL (no tumor present) then the high calcium would make the normal
parathyroid glands go to sleep and the PTH levels would be between very
low (say, between 5 and 8). At least 20% of ALL patients with
hyperparathyroidism are NOT DIAGNOSED appropriately because their doctor
does not understand this. Patient number is easy to diagnosis if the
patient is over 35 years of age (adults do not have persistent calcium
levels above 10.1). If the person is between 25 and 35 it could possibly
be hyperparathyroidism and more testing is necessary... this should not be ignored, and is
90% chance due
to a parathyroid tumor, but the difficulty comes from the fact that the
labs will bounce around a lot-- up and down. Remember, adults just don't live with calcium
levels which are constantly in the 10's... this is almost never normal. Patient 10 is the hardest patient to
diagnose. In cases where the calcium is high normal or intermittently slightly
elevated and the PTH is high, we
rely on lots of other information (for example, do they have significant
osteoporosis?, do they have kidney stones?, do they have symptoms of
hyperparathyroidism?, do they have excess calcium in their urine (These
are the only people that really need a urine calcium test), etc, etc. Patient number
10 needs a more
extensive workup, and a more lab studies than patients number 1-8
prior to heading off to the operating room. Patient 11 does not have
hyperparathyroidism and should not even
have their PTH tested...unless they pass a kidney stone and/or have severe
osteoporosis. Patient 11 often contacts us and asks us to consult with
them for hyperparathyroidism because they have "almost all of the
symptoms". Trust us, if your calcium and PTH are always normal, then
you don't need a parathyroid operation. If you are Patient 11, then please
realize that you must have LOTS of other testing by an
endocrinologist--parathyroid disease is not your problem, and we are not
in the position to help. As a final part of this exercise,
look at the colorful graph at the bottom of this page and see where
calcium levels are in normal humans and those with parathyroid disease. We
have a more advanced diagnosis
page on a different page of this web site.
will not operate on a patient unless they have two or more documented
blood tests showing elevated calcium and at least one blood test showing
elevated parathyroid hormone (although we do not require this in many
patients). Also, most surgeons have only seen
patients with scenarios 1 through 6 above, and they will get nervous
operating on the 25% of patients who don't present with
"classic" labs. Heck, many surgeons won't operate on patients
1-6 unless they have a positive sestamibi scan. This is fortunate for
you, because you probably want a very experienced parathyroid surgeon
operating on you anyway!
There are Two Different Calcium Levels in Your Blood
When you get your calcium level checked, they check
"Serum Calcium". Serum is the yellow liquid part of
blood--that part without the red and white blood cells. Serum
Calcium is the standard calcium that is most easily measured. Most
of the Serum Calcium floats around in the blood attached to random
proteins. The other type of calcium in our blood is called "Ionized
Calcium". Ionized calcium is the calcium in your blood that is
floating free of proteins, and thus very available to be absorbed
into nerve, muscle, and other cells that required calcium to perform
their duties. Ionized calcium is not checked routinely. It is more
expensive to check, will vary with the pH of your blood, and it
almost never requires checking in 'normal' people, unless they have
a problem with their Serum Calcium. Even most patients with
hyperparathyroidism will not need their Ionized Calcium checked...
it's not necessary because the Serum Calcium will be obviously
abnormal, and ALL of these people will have abnormally high Ionized
Calcium as well.
However, in patients who have Serum Calcium levels that are only
slightly elevated, or they are elevated and the PTH levels are
borderline high, THEN, the measurement of Ionized Calcium becomes
important. If you aren't sure you have hyperparathyroidism... ask
your doctor what your Ionized Calcium level is... but remember, it
is not necessary to measure this on most patients with parathyroid
level hormone calcium calcium controlled by parathyroid hormone.
TREATMENT OPTIONS FOR PRIMARY HYPERPARATHYROIDISM
The only two choices available for patients with primary hyperparathyroidism are to do nothing, or to have
surgery to remove the diseased parathyroid gland (tumor) (or infrequently, more than one diseased parathyroid gland). Some physicians will elect
not to refer their patients for an operation if they have a
"mild" form of primary hyperparathyroidism. Much of this management style stems from the fact that
standard parathyroid surgery in the past required the use of general anesthesia and was a major operation.
Parathyroid operations are not as "involved" as they once were, and usually
patients go home within 2 hours of the operation (when the operation is performed
by a parathyroid surgeon). Some new techniques of radioguided parathyroidectomy are also changing some of this "wait and see" attitude.
To read more about how endocrine doctors are changing the way they treat
parathyroid disease Click Here. Bottom
Line: The days of doing nothing for hyperparathyroidism are pretty much
gone... it is better for the patient and cheaper in the long run to
have a mini-parathyroid operation and fix the problem (usually 20 minutes or
even less by some experts -- go home in an hour or two).
If your doctor tells you that you have "MILD"
hyperparathyroidism and it can wait... then
click on our page of pictures of parathyroid tumors. You will see that
MILD hyperparathyroidism people have the same big tumor in their neck as
people with higher levels of calcium in their blood. You will also see
that patients with calcium levels above 12 can often have HUGE tumors...
and by then, these patients have severe osteoporosis and some have even
had a stroke. The advice to wait until your calcium goes higher makes no
sense, and is advice from the 1970's. We know much more now.
Parathyroid disease will ALWAYS get worse. It will never get better on its
it will never stay the same.
CAN OSTEOPOROSIS MEDICINES BE USED INSTEAD OF OPERATING ?
A dangerous trend
occurred in the late 1990's. Some physicians began using one the
osteoporosis drugs (Fosamax, Actonel, Evista, Boniva, Reclast, etc) to increase bone calcium rather than referring a patient for surgery.
These are very good drugs but must be used appropriately. They are NOT a substitute for removal of the overactive parathyroid
gland! IMPORTANT! These drugs work through a different mechanism than does the overproduced parathyroid hormone.
There has never been a clinical study that shows Fosamax or Actonel (or
any other drug) can be
used in patients with parathyroid disease. These drugs do not work on the bone
in the same place as parathyroid hormone (PTH), and they cannot overpower
the powerful effects of PTH. There is more written about this on
other pages of Parathyroid.com. Remember, parathyroid disease is caused by
a tumor on one (or rarely more than one) of the parathyroid glands. Giving an osteoporosis
medicine will not make the tumor go away. Read more about Fosamax,
Actonel and other osteoporosis drugs on our Osteoporosis Page and
our Frequently Asked Questions Page.
Is it possible to have hyperparathyroidism and
not have a high parathyroid hormone level?
ABSOLUTELY! This is an advanced paragraph, and it may confuse a
lot of people. Remember, 75% of people with hyperparathyroidism will
have high calcium levels and high PTH levels. Some will not be this
simple. This section is about that 25% of people with high calcium
levels and normal PTH levels, and less frequently, those with normal calcium levels
and high PTH levels. See the colorful calcium graph below.
Although MOST people with hyperparathyroidism have the classic
presentation of high calcium in the blood and high parathyroid
hormone (PTH) in the blood, about 20% of people with very
significant parathyroid disease
will have high calcium and normal PTH levels. This is very
important... it was discussed in the table above, but we are doing
it here again because most of these patients are not being diagnosed
correctly... it is overlooked by many endocrinologists
(some endocrinologists just
don't see many patients with this disease). Every DAY we operate on
at least 2 patients with hyperparathyroidism who have high
calcium levels but never had a high parathyroid hormone level. Every
one of these patients is found to have a bad parathyroid gland (a
parathyroid tumor) and
they get better after the operation. How can this be? Well, think
this through with us... The parathyroid glands
control the calcium in the blood. If the calcium in the blood is
ever high, "normal" parathyroid glands would sense the
high calcium and turn themselves off--and the PTH level would be
near zero. Thus, if the PTH level is in the normal range when the
calcium is high, then there is something wrong with the parathyroid
glands, and one (or more) of them has lost their ability to 'turn
off' and it is stuck in the 'on' position. This bad parathyroid
gland must be removed. Think of it this way... a "normal"
parathyroid hormone level is only normal if your calcium is normal.
If your calcium is high, then a "correct" parathyroid
hormone would be near zero... if your parathyroid glands are normal.
If not, then it is the parathyroid glands that are CAUSING the
calcium to go high. Have we totally confused you yet?
75% of people with hyperparathyroidism will have high calcium
and high PTH levels (like patients 1 through 6 in the table
above). Many of these people will have labs that
jump around, with the calcium going from high to normal and back to
high; and PTH levels going up and down. It is very easy to make the
diagnosis of hyperparathyroidism in these people and they will all
get an operation sooner or later. Of course, waiting just makes
things worse--discussed elsewhere.
20% of parathyroid patients will have high calcium levels
but their PTH levels will be in the normal range (like patients
3, 7 and 8 in the table above). These people
can be a little more difficult to diagnose, and quite a few doctors will
not make the correct diagnosis (they don't see
enough of these to have the experience). These people often will
have lots of symptoms. Their calcium is high (typically around 10.5
to 11.6) but their PTH levels are still in the "normal" range.
Most of these patients have PTH levels between 40 to 60. If your calcium is
frequently or persistently high, and your PTH isn't
then you very likely have hyperparathyroidism. There are
many thousands of people in the US who are misdiagnosed every year
because their doctors don't know this. These patients will go
to the doctor for years getting their calcium and PTH checked every
few months while the doctor waits for the stars to align and the
patient to have high calcium AND high PTH on the same test. This is
silly... but at least 10% of you reading this have gone through this
exact situation. Be careful... we get some folks with one high
calcium level, a bunch of normal calcium levels, and a bunch of
normal PTH levels and they think they have a parathyroid tumor--they
do not. The concept here is "trends over time" and
repeated levels. Repeated calcium levels above 10.4 and repeated PTH
levels above 25 in a person over the age of 40 is almost always a
2-5% of parathyroid patients will have normal calcium
levels and high PTH levels (like patient number 10 in the table
above). These patient are some of the
hardest to diagnose, but two things are very common in this group 1)
high ionized calcium levels and 2) kidney stones. Thus, if you
had a recent bout of kidney stones and your calcium is
"normal", make sure you check ionized calcium levels and
PTH levels. Checking the urine for the amount of calcium in the
urine is also a good test for this group... (a test that is not very
helpful or necessary for most patients)
Patients in all three
categories have hyperparathyroidism, and all of them will need
surgery. They will all benefit from surgery.
Normal and Abnormal Blood Calcium Levels
The following graph of normal blood calcium levels appears
quite complex, but it is not. Do not let it confuse you. If you are
reading this web page, chances are you have had at least one high calcium
level and aren't sure what this means. You are on this graph in
the red area. Remember, patients with hyperparathyroidism have a
parathyroid tumor that prevents accurate regulation of calcium levels in
the blood... thus the calcium levels bounce around a lot. Most people with
a parathyroid tumor have calcium levels that bounce around from high to
the high end of normal. People with normal parathyroid glands have calcium
levels that are very constant from week to week, month to month, and year
to year--their calcium levels do not bounce around between high and
normal. Study this graph carefully. Start at the top left of the graph and work your way around
the graph clockwise to understand what normal calcium levels are and what
it means to have a high calcium level.
There are several mistakes we see on a daily basis when
doctors are trying to make the diagnosis of hyperparathyroidism in a
patient who has a high calcium. The first mistake
is that they say "it could be a lab error so we'll check it
again". Lab errors are extremely rare these days, but checking it
again is correct. The mistake comes when the next calcium level comes back
in the "normal range" and the doctor says..."your calcium
is normal, there is nothing to worry about". This is a mistake we see
in about 80% of all patients with hyperparathyroidism. This is why most patients who undergo surgery to remove the tumor have had the disease for
a minimum of 5 years. The doctor was on the right track, but got
fooled when the calcium level came back in the normal range. These doctors
don't understand that people with hyperparathyroidism have calcium levels
that bounce around, and so we expect the calcium level to be up one day
and down the next (in fact, almost all people with hyperparathyroidism
have good days and days when they feel real bad... this is due to the
fluctuations in calcium levels that normal people do not have... when the
calcium is high, they are feeling down, tired, depressed, fatigued).
People with normal parathyroid glands do not have calcium levels that
bounce around. Our brains run on calcium... this is why the human body
controls calcium to a much higher degree than any other element in our
bodies. We adults feel good when our calcium is constant, not fluctuating, and
somewhere in the 9's.
The second major mistake
regarding calcium levels is that doctors think that having calcium
levels in the "low 10's" is normal since it says so on the lab
slip (all lab reports come with a "normal range" printed right
next to the result). The fact is, it is normal for adults to occasionally
calcium levels in the low 10's (the yellow area on the graph above).
However, it is not normal for adults over 30 to have persistent calcium
levels above 10.1. Only teens and adults under 25-30 can have
calcium levels in the low 10's and still be normal. Not us adults over 40!
This is not normal for adults (the lab reports normal ranges for all
humans and it is not corrected for age. Adults over 40 should only rarely
have a calcium level of 10.0 or higher. Also, we adults do not like having calcium levels in the 10's. Almost
all adults feel best with a calcium level somewhere in the 9's. The graph
show you where calcium levels are in 14,000 patients that we operated on to
remove a parathyroid tumor. These are their HIGHEST calcium levels, so
each patient here had a number of calcium levels that were lower than
this highest number.
You can see from this graph that most people with a
parathyroid tumor have their highest calcium level about
10.9. This means that their AVERAGE calcium levels were in the mid to upper
10's (they have calcium levels that bounce around in the mid to upper
The third major mistake we see doctors
make when looking at blood calcium levels is that they will say "your calcium levels are
a little high, but
they aren't all too high, so we'll just watch it". These
doctors will wait and see if your calcium goes any higher, possibly past
some "magic" number like 11.5 (a common "magic" number
we hear). Well it turns out that only 32% of the last 15,000 patients we
operated on ever had even ONE calcium level that was 11.5 or higher. You
can see from this graph, that most patients with a parathyroid tumor have average
calcium levels in the mid to upper 10's and their highest number is
usually 11 or lower. So if you
are waiting for this "magic" number, your tumor will continue to grow, you
will continue to feel bad (see our symptoms
page), you will continue to get worsening of your osteoporosis, and
you will lose the joy of life. And... while you are feeling bad and
your bones, heart, and kidneys slowly get destroyed by the high calcium,
chances are that you will never get to the "magic" number
of 11.5. Most people will never get calcium levels that high (only 23%
do), and if they
do, they have more damage done to their bodies. The severity of hyperparathyroidism CANNOT
be measured by how high the calcium levels are. The size of the tumor
cannot be predicted based upon how high the calcium levels are. You either
have parathyroid disease or you do not. How high the calcium is doesn't
have a parathyroid problem or you do not. It is a yes/no question. It is
not a question of "mild" or "severe". Yes or no. If you
do have a parathyroid problem, then get the tumor
removed. As we always say, the lady who is 8 months pregnant is not
"more" pregnant than the lady who is 6 months pregnant.
If you haven't seen our page of pictures
of parathyroid tumors, this would be a good time, since they came from
people who are in the middle of this graph.
Blood Calcium Levels Are Different as We Get Older
A very common mistake we see is that doctors don't realize
that NORMAL RANGE for blood calcium changes as we go through different
stages of our life. This is propagated by the labs where you get your
blood done--they do not give normal ranges according to the patient's age.
Instead, they often give the normal range for ALL HUMANS, which is about
8.8 to 10.7 mg/dl. But as you can see from the green area on this graph,
the normal range for blood calcium is dependent upon your age.
Although it is true that normal blood calcium can be between 8.8 and 10.7,
it is never that range for any one human. When we go through our
growth-spurt during our teenage years, we grow lots of bone and our bones
become more and more dense. During these years, we have lots more calcium
in our blood because we are "turning over" and
"remodeling" our bone structure. By the time we get to be
30 years old, the calcium levels decrease normally, and by the time we are
40 we are not allowed to have calcium levels above 10.1 (see the green
A VERY COMMON problem we see is that the labs will report
the upper limit of normal for blood calcium as 10.7 mg/dl (or 10.4, or
10.5), and the doctor says "your blood calcium is 10.5, that is
normal". IT IS NOT NORMAL if you are 35 years old or higher. Adults
over 35 are not allowed to have calcium levels "in the
10's". It is that simple! Adults are supposed to have
"calcium levels in the 9's". Most people with parathyroid
tumors have calcium levels in the 10's! Print this picture and teach
For the scientists in the crowd that are interested, the
statistics for calcium levels in 10,000 patients who had a parathyroid tumor
removed from their neck at the Norman Parathyroid Clinic in the past 6 years
ending July, 2010 were recently
published (January 2011) in the number one endocrine journal. Here are
Mean calcium: 10.894; Median: 10.9; Mode: 10.7; Standard Deviation: 0.597. Percent with average calcium at or below 11.4:
85.57%; Percent with average calcium at or above 11.5: 14.43%.
Percent who never had a single calcium level of 11.5 or higher:
79%. Percent that had even one calcium level of 11.5 or higher:
Understand that 79% of patients sent to us for parathyroid
surgery never had a calcium level that went over 11.4. It just
doesn't happen very often. So if your endocrinologist is waiting
until your calcium goes above 11.5 before sending you for surgery, knot
that this is simply not founded in medical facts and is not in your best
interest. The calcium doesn't just keep climbing as the tumor gets
bigger--it may kill you before it does that. Waiting for surgery
until your calcium levels go above 11.5 is dumb, is not based on medical
facts, and is not standard of care in the US or any other country.
One final note... this graph shows blood CALCIUM
levels in patients with primary hyperparathyroidism. This graph is
DIFFERENT from the graph on our Hyperparathyroidism
page which shows parathyroid hormone (PTH) levels in patients with primary
hyperparathyroidism. These graphs have the same shape and thus you could
confuse them... but one looks at the calcium levels in the blood, and the
other looks at the PTH levels in the blood. These two graphs are
central to the diagnosis of hyperparathyroidism.
Finally, we'd like to point out that measuring the amount
of calcium in the urine is not mentioned on this page because it is a test
that is not used much anymore to diagnose parathyroid disease (only about
20% of endocrinologists order this test anymore). If your blood calcium is
high, then it really doesn't matter what your urine calcium is--- you have
parathyroid disease. Also note that measuring Vitamin D is not mentioned
on this page, because Vitamin D has nothing to do with the diagnosis of
primary hyperparathyroidism. This is VERY confusing to most
endocrinologists, and most will order this test. However, it doesn't
matter what your Vitamin D level is, if your calcium level is high, you
have a parathyroid tumor. We have an entire page on Vitamin D... but it is
an advanced page... don't go there yet... BOTTOM LINE... Vitamin D levels
and Urine Calcium levels are almost never used to determine if somebody
has hyperparathyroidism or not. We sure wish we could teach this to a lot
We have another large and complex page that discusses
the diagnosis of primary hyperparathyroidism in more detail. This page
is written for the benefit of doctors. If you are a patient... do not go
there yet until you read about surgery and mini-parathyroid surgery that
will fix your problem almost always in less than 20 minutes. If you are a
doctor, then the advanced page is for you. If you are a patient and you
are really getting into this... then our Advanced
Diagnosis page is for you. It is the best page of parathyroid.com
next pages to read:
Read this page again.
If you understand this page well, then you understand parathyroid
disease better than 95% of doctors. Also, if there was ONE page that
you want to print and take to your doctor...this is the page. Print
this page and our Advanced
Diagnosis Page and take it to your doctor.
parathyroid tumors. This page is very helpful because it
allows you to see the different size tumors we have removed from
patient's necks, and allows you to compare their tumor with their
calcium and PTH levels... You will find one just like yours on this
Overview. This page has a very good explanation of how the parathyroid
glands regulate the calcium--like the thermostat in your home. Must
Watch a great video
of Dr Norman describing in simple terms what hyperparathyroidism
is. (award winning video).
Surgery and mini-parathyroid surgery.
If you like learning by video, then visit
our Teaching Videos Page where you can watch short video clips on most parathyroid topics.
This page was last updated 12/05/2013