Primary Hyperparathyroidism

[qeddie]

Hi,

not exactly a thyroid problem, but I did not found a special community for parathyroid / other endocrine problems

Man, 48 years, 180 cm, 100 kg, incidentally found hypercalcemia 2.9 mmol/l (I was quite dehydrated at that time), verified a month later

pathological/borderline values:
Ca 2.8 mmol/l (ref 2.1-2.6)
PTH 85.7 pg/ml (15-65)
D25-OH 22 ng/ml (30-70)
Phosphate anorg 0.8 mmol/l (0.8-1.6)
Na 145 mmol/l (135-146)
uric acid 7.4 mg/dl (3.4-7.0) - this exists at least a year
GPT 63 U/l (60 ml/min (no precise result, however a year ago at other lab computed at 97 ml/min), so there should not be a kidney problem

B12 639 (145-569)

ALP, albumin, calcium in urine, ionized Ca, D3 1,25, bone density scan were not done (yet)

Neck sonography was unremarkable, abdominal one including kidneys as well

I have no symptoms attributable to hypercalcemia - no GIT problems, no polydipsia/polyuria, no bone pains, never had a problem with kidneys, no physical weakness, no mental problems. This is the first time they did electrolytes, so I have no idea how long this condition exists.

I know that the surery is usually indicated even for asymptomatic pHPT under 50 years. I am however reluctant to have a surgery in this a bit risky region if it is not clear which/where the responsible gland is in advance. So I have several questions

- how risky is the wait&watch approach with these Ca and PTH values?
- some studies claim that bringing D3 above 50 could bring the PTH down (but won't change the Ca level), others warn that the Ca could rise dramatically because of better absorption. Opinions? Did anyone try D3 in the > 2000 IU daily range with pHPT and mild hypercalcemia?
- is there a way to limit bone deterioration in the higher PTH setting, such as K2 supplementation (beyond increasing weight-bearing physical activity)?

Many thanks

[qeddie]

Hi Barb, thanks for the reply. I have already read parathyroid.com - lots of information, but that is obviously a site run by the doctor who makes his living doing the surgeries, so he definitely will not recommend wait and watch. The SEO done here is remarkable - there is more than one site and it pops up in search results everywhere. Other protocols do consider waiting and watching for asymptomatic patients, although most recommend getting the surgery if one is younger than 50 (I am 48).

Despite what he says, the neck with the unknown location of the affected gland(s) - that might even not be in the neck in some percentage of the cases - is not an easy surgery. There is some risk of damaging the laryngeal nerve and I try to weight the risk of getting kidney stones and/or brittle bones later in life (that is not 100%) to the risk of complications of the surgery (that is not 0%). I am not in the U.S. and I have no idea what center has what complication rates.

The - admittedly small - study here http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3681316/  (search for "Prolonged treatment with vitamin D in postmenopausal women with primary hyperparathyroidism" if the link does not get through) did demonstrate lower PTH and unchanged Ca after the treatment with high doses of D3. There are other studies linking the D3 level with the goeth of the adenoma. The tumour won't go away, but it won't necessarily grow either.

Symptoms, demonstrated declining bone density or the adenoma showing up on sonography or other test would of course mean me going for the surgery.

[Barb135]

I'm definitely not an expert on hyperparathyroidism, but I've read that taking vitamin D is contraindicated.

I've also read that "wait and watch" doesn't work because a parathyroid tumor does not go away.

If you haven't already, you can find a wealth of information at the following site:  www.parathyroid.com

[qeddie]

umm, something got garbled here, probably because of a "less/mor than" sign. Insert following between GPT and B12:

uric acid 7.4 mg/dl (3.4-7.0) - this exists at least a year
GPT 63 U/l (below 50) - I always have this a tad higher (25+ years)

other data are unremarkable
FT3 2.36 pg/ml (2.15-4.12)
FT4 1.63 ng/dl (0.70-1.70)
TSH 0.83 uU/ml (0.3-4.0)

computed GFR more than 60 ml/min (no precise result, however a year ago at other lab computed at 97 ml/min), so there should not be a kidney problem