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Secondary HPT

Secondary hyperparathyroidism (sHPT) occurs when PTH rises as a result of chronically low blood calcium levels. In sHPT, all four parathyroid glands become overactive and enlarged (called hyperplasia).

During parathyroid surgery for primary hyperparathyroidism (high calcium preoperatively), I was found to have hyperplasia. My calcium is now normal but I have read that patients with hyperplasia have a higher chance of developing recurrent disease. What are the chances that I will get this again?

Parathyroid hyperplasia in primary hyperparathyroidism can be tricky. Adenomas are straightforward: one "bad" gland is removed, and the normal ones are left behind. With hyperplasia, all four glands are involved, by definition. There are no completely normal glands. This is why we have to remove 3.5 glands, to debulk the parathyroids. In most cases, this produces a long-term cure. Meaning, that...

Primary HPT Hyperplasia Secondary HPT Cure rate

Can celiac disease cause hyperparathyroidism?

Celiac disease, or any disease that causes chronic diarrhea or intestinal malabsorption, can cause secondary hyperparathyroidism - not primary hyperparathyroidism. In secondary hyperparathyroidism due to celiac disease, the calcium is chronically low because the intestines have difficulty absorbing it. The PTH rises in response to the low calcium. All four parathyroid glands will produce more P...

Secondary HPT Malabsorption Celiac disease

Over the last few years my calcium levels have been a little low, between 8.8 and 9.1 mg/dl. My PTH levels have been very high, up to 200 pg/ml. I had a gastric bypass 7 years ago, and one doctor told me that the PTH was a result of that. Another doctor told me that I have primary hyperparathyroidism and need surgery to remove a parathyroid tumor. Do I have primary hyperparathyroidism? Do I need surgery?

This clinical picture is most consistent with secondary hyperparathyroidism (not primary) due to intestinal malabsorption of calcium (as a result of the gastric bypass). Secondary hyperparathyroidism occurs when blood calcium levels are chronically low. Most people should have calcium levels in the mid to high 9s in mg/dl, or between 2.32 and 2.5 mmol/l. If calcium levels are consistently b...

Secondary HPT Gastric bypass Malabsorption

My calcium levels have been normal (around 9.5 mg/dl) but my PTH is consistently elevated, between 60 to 80 pg/ml (normal range up to 65 pg/ml). Do I have parathyroid disease?

Most of the time, this clinical picture does not indicate primary hyperparathyroidism. The PTH is a little bit over the "normal" range, but with calcium levels that remain in the normal range, a parathyroid tumor is unlikely. If your calcium level were high (that is, over around 10.0 mg/dl for adults over age 40), then I would diagnose primary hyperparathyroidism. But with normal calcium levels...

Diagnosis Secondary HPT

Three years ago I had a parathyroid tumor removed. I did very well, but recently my PTH has gone up to 85 pg/ml (normal range up to 65 pg/ml). Do I have another parathyroid tumor? My last calcium was 9.1 mg/dl.

Your labs are now more consistent with secondary hyperparathyroidism (not primary hyperparathyroidism, which is what you had three years ago). That is, the parathyroid glands are making more hormone in response to a low calcium level. Ideally you want your calcium level to be closer to the mid to high 9s in mg/dl. Your remaining parathyroid glands are doing exactly what we want them to do when ...

Postop expectations Diagnosis Secondary HPT

What is Parathyroid Disease?

Parathyroid disease refers to problems with the parathyroid glands. Almost everyone has four parathyroid glands, located in the neck near the thyroid. These glands exist to regulate blood calcium levels, so parathyroid disease is fundamentally a problem of calcium. The calcium in your blood is kept in a very tight range - your body doesn't want it too low or too high. The parathyroids are what ...

Diagnosis Primary HPT Popular Secondary HPT Parathyroid Disease Basics FAQ

My PTH is high (118 pg/ml), but my calcium is normal at 9.6 mg/dl. My urine calcium 24hr is 207. What would this indicate? Normal? Way weird?

Thanks for asking! The short answer is that your labs are in a gray zone, so with just this information, it is not possible to make a definitive diagnosis. To figure out what is going on, I would need to get a thorough history and would want to see more labs. I'll go through my process here. There are two possible diagnoses that could explain your labs: 1. Normocalcemic primary hyperparathy...

Secondary HPT Diagnosis primary hyperparathyroidism Normal calcium

What makes my parathyroid level go up? My PTH is 91 pg/ml.

Since a "normal" PTH level is typically between 20 and 50 pg/ml, your parathyroid hormone level is definitely high. But we don't yet have enough information yet to know why. To figure out why your PTH level is high, we need to know your calcium level. Parathyroid glands are designed to respond to blood calcium levels. When the calcium level is low, they make more hormone (PTH) in order to b...

Secondary HPT Diagnosis Parathyroid Hormone (PTH)