Hyperparathyroidism is a disease caused by excessive production of a hormone called parathyroid hormone (PTH). This hormone is produced by the parathyroid glands, small glands located in the thyroid area.
The role of parathyroid hormone is to increase calcium levels in extracellular fluids.
This is achieved by:
- loss of calcium in bones;
- activation of vitamin D3, and thereby increasing calcium absorption in the intestine;
- decreased renal excretion of calcium (at the same time increased excretion of phosphate).
Therefore, hyperparathyroidism is associated with:
- increased levels of parathyroid hormone;
- increased calcium;
- reduced concentration of phosphates.
This is important for diagnosing and treating the disease.
Parathyroid hormone - what is it?
Parathyroid hormone is a hormone of the parathyroid glands
(it would be more correct to say “parathyroid glands”, but many patients are already very accustomed to the term “parathyroid glands”, although it is not entirely correct from the point of view of word formation).
Parathyroid hormone production
produced by parathyroid cells in response to a decrease in the level of ionized calcium in the blood. On the surface of the cells of the parathyroid glands there are special receptors that are able to assess the concentration of ionized calcium in the blood and, in accordance with its level, produce parathyroid hormone in larger or smaller quantities.
Very often the term “ parathyroid hormone”
"(parathyroid hormone - from parathyroid hormone) is written incorrectly, since it can be difficult for a non-specialist to hear all the features of the correct spelling.
Often on the Internet you can come across terms such as “ parad hormone
”, “
parade hormone
” and even “
parade of hormones
”. The correct term, of course, is one - parathyroid hormone (written together and without a hyphen).
Parathyroid hormone is a polypeptide hormone
(i.e. consisting of amino acids). There are 84 amino acid residues in the parathyroid hormone molecule. Currently, the structure of parathyroid hormone has been completely deciphered by scientists. It was found that in the parathyroid hormone molecule, the first 34 amino acid residues are responsible for the biological activity, and the rest are responsible for the binding of the hormone to receptors and the stability of the molecule as a whole.
The main effect of parathyroid hormone is to increase the level of ionized calcium
in blood. This action is realized through three different effects.
Firstly, parathyroid hormone enhances the activation of vitamin D in the kidneys
, which leads to the formation of an important hormone-like substance, calcitriol, from vitamin D. Calcitriol stimulates the absorption of calcium in the intestine, which leads to an increased flow of calcium from food into the blood. A prerequisite for the implementation of this effect of parathyroid hormone is the presence of a sufficient amount of vitamin D in the body. Without sufficient supply of vitamin D in the blood, parathyroid hormone is not able to enhance the absorption of calcium in the intestine.
Secondly, parathyroid hormone enhances the reabsorption of calcium ions from primary urine
. This effect is realized at the level of the renal tubules.
Thirdly, parathyroid hormone enhances the activity of osteoclasts
– cells that destroy bone tissue. Osteoclasts, like bulldozers or excavators, begin to actively destroy bone beams and release the resulting calcium into the blood. As a result, the concentration of calcium in the blood increases, but the strength of bone tissue decreases, which increases the likelihood of fractures.
Parathyroid hormone is a very interesting hormone, since the effect of parathyroid hormone on the bone directly depends on the mode of its production
. Everything that we said above about the negative effect of parathyroid hormone on bone tissue is true only for cases when parathyroid hormone is constantly and continuously elevated. At the same time, periodic and short-term release of parathyroid hormone into the blood has a positive effect on bone tissue, leading to increased formation of bone beams and bone strengthening. Now this effect is used in the treatment of osteoporosis - even a medicinal analogue of parathyroid hormone (teriparatide) has been synthesized, the periodic administration of which into the body can increase the strength of bone tissue and reduce the likelihood of fractures.
Indications for PTH test
| Disease | Clinical manifestations for which the test is prescribed |
| Hypercalcemia - characterized by an increase in total calcium in plasma above 3.0 mmol/l, ionized calcium - 1.5 mmol/l against the background of normal protein levels. | The intensity of symptoms directly depends on the initiating factors and severity of the disease. Patients complain of various manifestations:
|
| Hypocalcemia is a pathological condition characterized by a decrease in the concentration of total Ca below 1.87 mmol/l, ionized calcium - 1.07 mmol/l. |
|
| Neoplasms of the parathyroid glands of benign and malignant etiology. | Diagnostics is required if there are pathological changes in the volume and structure of glandular tissue, determined using hardware studies, as well as during the rehabilitation period after surgical removal of the tumor. |
| Osteoporosis is characterized by a decrease in bone density. | The study allows us to identify disruptions in the metabolism of phosphorus and calcium and is carried out when the patient complains of pain in the back or changes in posture. Indications also include cystic formations of bone tissue and sclerotic changes in the vertebral bodies, identified by instrumental diagnostics. |
| UCD - stones in the urinary system | The test is performed on patients suffering from chronic kidney pathologies when X-ray positive stones are detected to clarify the initiating factor. |
The procedure has no contraindications, since it does not have a negative effect on the body and is painless.
Parathyroid hormone production
The production of parathyroid hormone is regulated by the level of ionized calcium
in blood. If calcium in the blood decreases, parathyroid hormone begins to be released more actively.
On the surface of the cells of the parathyroid glands there is a calcium-binding receptor, which is directly able to “sense” the concentration of calcium in the blood and regulate the rate at which parathyroid hormone is produced. This is the only receptor currently known to science that is “controlled” not by peptides or hormones, but by the substance itself—or rather, by its ions. Be that as it may, parathyroid hormone is normally produced by the parathyroid glands only when the concentration of calcium in the blood decreases.
How to properly prepare for a PTG study?
The procedure is aimed at collecting venous blood and requires proper preparation from the patient, namely:
- Refusal to eat food at least 10 hours before the procedure and visit the clinic between 7 and 9 am;
- Avoid physical activity, stress and alcohol consumption 24 hours before the test;
- Stop smoking three hours before blood sampling;
- Excluding dairy products from the diet for several days before the procedure;
- Carrying out hardware examinations and physiotherapy after the test.
In addition, the patient needs to inform the doctor about the use of any pharmacological medications and pregnancy.
Parathyroid hormone and calcium
There are two “friends” in the body, two substances that are inextricably linked - parathyroid hormone, calcium
.
At the same time, there is a relationship between them, which in endocrinology is described as “double feedback”. They sort of regulate each other. When the level of calcium in the blood decreases, parathyroid hormone begins to be released more strongly, as a result of which calcium in the blood increases and acts on the cells of the parathyroid glands through the receptor, causing them to stop releasing parathyroid hormone. After the release of parathyroid hormone ceases, calcium begins to gradually decrease until it reaches a level at which the cells of the parathyroid glands are activated with the release of parathyroid hormone - and the cycle repeats. Calcium is the main thing that parathyroid hormone influences, and at the same time parathyroid hormone is one of the most important substances that calcium influences
.
Symptoms of hyperparathyroidism
Initially, the disease is asymptomatic, then consequences develop:
- Destructive activity of excessive levels of parathyroid hormone - disorders of bone mineralization (most often osteoporosis);
- Formation of calcium deposits (nephrolithiasis, cholelithiasis, pancreatitis);
- Disorders associated with excessive calcium levels (hypercalcemia) - severe dehydration and other serious problems with the absorption and excretion of water and electrolytes (excessive calcium levels impair the density of urine).
Osteoporosis
Pancreatitis
Parathyroid hormone and calcitonin
Unlike substances such as calcium, parathyroid hormone and calcitonin are “enemies”, antagonists
.
Parathyroid hormone aims to increase the level of calcium in the blood, and calcitonin aims to reduce it. Parathyroid hormone stimulates the destruction of bone beams with a prolonged increase, and calcitonin, on the contrary, causes the formation of new bone tissue and thereby strengthens the bone. The relationships between hormones, if you dig deep, are even deeper - for example, in some hereditary syndromes (multiple endocrine neoplasia syndrome, MEN), tumors simultaneously develop that produce both hormones - parathyroid hormone, calcitonin. Therefore, when examining for elevated parathyroid hormone, calcitonin is required
.
Vitamin D and parathyroid hormone
Vitamin D and parathyroid hormone are substances whose effects are similar and largely depend on each other. Both substances - vitamin D and parathyroid hormone - their main effect is to increase blood calcium levels
. As is the case with calcium, parathyroid hormone and vitamin D can influence each other. This effect is very interesting and is implemented in general terms like this. When the level of calcium in the blood decreases, the cells of the parathyroid glands begin to actively produce parathyroid hormone, which enhances the hydroxylation of vitamin D in the kidneys and the formation of calcitriol, the active form of vitamin D, which, due to the strength of its action, can be confidently recognized as a hormone. Calcitriol, on the one hand, enhances the release of a special transport protein in the intestinal wall - calmodulin, which “drags” calcium from the intestinal lumen into the blood, and on the other hand, it directly acts on a special receptor on the surface of the cells of the parathyroid glands (it is called the vitamin receptor D or VDR, vitamin D receptor). Activation of the vitamin D receptor leads to suppression of the proliferation of parathyroid gland cells, i.e. indirectly acts to reduce parathyroid hormone levels.
It is important to understand that a decrease in the intake of vitamin D into the human body leads to a “disinhibition” of the division of cells of the parathyroid glands and at the same time to stimulation of the production of parathyroid hormone by these cells. This occurs when there is little sun exposure to the skin, since vitamin D is produced in human skin. The second cause of vitamin D deficiency is insufficient intake of vitamin D from food. Low vitamin D in the blood leads to a low intake of calcium into the blood, which activates the production of parathyroid hormone by the cells of the parathyroid glands.
Vitamin D deficiency has been proven to increase the incidence of benign tumors
– adenomas of the parathyroid glands (probably due to the elimination of the inhibitory effect of vitamin D on the division of cells of the parathyroid glands due to its deficiency).
The second common situation with which patients come to the North-Western Endocrinology Center is the so-called secondary hyperparathyroidism, i.e. a condition in which parathyroid hormone is elevated in the blood, but calcium is normal
. The detection of normal or reduced calcium simultaneously with an increase in parathyroid hormone levels usually indicates a low level of vitamin D in the blood. You can, of course, conduct a blood test for vitamin D, but you can do it differently - prescribe vitamin D and calcium supplements to the patient, and after 1-2 months, repeat the blood test for parathyroid hormone and ionized calcium. If a repeated analysis reveals a decrease or normalization of parathyroid hormone, and the calcium level is normal, this will indicate with a high degree of certainty that the patient simply needs to take calcium and vitamin D supplements longer. If a repeated blood test shows that parathyroid hormone is is still high, and calcium has increased above normal - this will indicate that the patient has primary hyperparathyroidism, a tumor of the parathyroid gland.
Parathyroid hormone (PTH) is a polypeptide hormone that is synthesized by the parathyroid glands and plays an important role in regulating calcium and phosphorus levels in the body.
Synonyms Russian
Parathyroid hormone, parathyrin, PTH.
English synonyms
Parathyroid hormone, intact PTH, parathormone, parathyrin.
Research method
Solid-phase chemiluminescent enzyme-linked immunosorbent assay (“sandwich” method).
Determination range: 1.2 - 5000 pg/ml.
Units
Pg/ml (picograms per milliliter).
What biomaterial can be used for research?
Venous blood.
How to properly prepare for research?
- During the day before the test, do not drink alcohol or take medications (as agreed with your doctor).
- Do not eat for 12 hours before the test.
- Avoid physical and emotional stress for 24 hours before the test.
- Do not smoke 3 hours before the test.
General information about the study
Parathyroid hormone (PTH) is produced by the parathyroid glands, located in pairs on the posterior surface of each lobe of the thyroid gland. Intact PTH (the whole hormone molecule) consists of 84 amino acids, has a short half-life (about four minutes) and is the main biologically active form of the hormone. Its N- and C-terminal fragments have a longer lifespan, and their activity and metabolism are being studied.
PTH plays an important role in the regulation of phosphorus-calcium metabolism and ensures the maintenance of stable concentrations of calcium and phosphorus in the extracellular fluid. The level of PTH is closely related to the amount of calcium, vitamin D, phosphorus, calcium, magnesium in the body; the regulation of its secretion is carried out according to the feedback principle. When the concentration of calcium in the blood decreases (hypocalcemia), the release of PTH by the parathyroid glands increases, and when it increases (hypercalcemia), on the contrary, it decreases. These mechanisms are aimed at maintaining a stable level of calcium in the blood. An increase in PTH promotes the activation of osteoclasts, bone resorption and the release of calcium from bones, enhances the absorption of calcium from the intestine, delays the excretion of calcium by the kidneys and inhibits the reverse reabsorption of phosphorus. The PTH antagonist is the hormone calcitonin, secreted by the C cells of the thyroid gland. Normally, when the normal concentration of calcium in the blood is reached, PTH production decreases.
With pathology and excessive synthesis of PTH (hyperparathyroidism), hypercalcemia, hyperphosphaturia, generalized osteoporosis, vascular calcification, and damage to the gastrointestinal mucosa develop. Insufficient secretion of PTH (hypoparathyroidism) is accompanied by hypocalcemia and hyperphosphatemia and can lead to convulsions and tetany.
It is important to simultaneously assess the level of free, or ionized, calcium in the blood and PTH, taking into account clinical manifestations and the results of other laboratory and instrumental studies, this allows for differential diagnosis of very similar pathological conditions and development of the correct treatment tactics.
What is the research used for?
- To assess the function of the parathyroid glands.
- To find out the causes of hypo- or hypercalcemia, calcium metabolism disorders.
- For differential diagnosis of primary, secondary and tertiary hyperparathyroidism.
- For the diagnosis of hypoparathyroidism.
- For monitoring patients with chronic calcium metabolism disorders.
- To evaluate the effectiveness of treatment of pathology of the parathyroid glands and their surgical removal for neoplasms.
When is the study scheduled?
- When the level of calcium in the blood changes (hyper- or hypocalcemia).
- For symptoms of hypercalcemia (fatigue, nausea, abdominal pain, thirst) or hypocalcemia (abdominal pain, muscle cramps, tingling fingers).
- When the size and structure of the parathyroid glands change according to instrumental methods (for example, CT).
- In the treatment of calcium metabolism disorders.
- For neoplasms of the parathyroid glands, as well as immediately after their surgical removal.
- For osteoporosis and changes in bone structure.
- For chronic kidney disease and reduced glomerular filtration rate.
What do the results mean?
Reference values: 15 - 65 pg/ml.
A normal level of PTH with low calcium in the blood is a sign of hypoparathyroidism (insufficient synthesis of PTH by the parathyroid glands). High PTH and elevated blood calcium concentration indicate hyperparathyroidism. The PTH level is assessed together with the blood calcium level.
Causes of increased parathyroid hormone levels
- Hypocalcemia (with normal function of the parathyroid glands, the level of PTH increases in order to mobilize calcium from the depot and increase its absorption).
- Primary hyperparathyroidism (accompanied by increased levels of calcium and calcitonin, the level of phosphorus in the blood is normal or reduced):
- hyperplasia of the parathyroid glands,
- adenoma or cancer of the parathyroid glands.
- chronic renal failure,
- vitamin D and calcium deficiency,
- malabsorption syndrome.
Causes of decreased parathyroid hormone levels
- Hypercalcemia (a decrease in PTH with normal function of the parathyroid glands contributes to a decrease in the concentration of calcium in the blood).
- Primary hypoparathyroidism (insufficient function of the parathyroid glands).
- Secondary hypoparathyroidism (for example, a complication of surgical treatment of thyroid diseases, a condition after removal of the parathyroid glands).
- Excess vitamins A and D.
- Idiopathic hypercalcemia.
- Autoimmune diseases with the formation of autoantibodies to calcium receptors.
- Wilson-Konovalov disease, hemochromatosis.
- Graves' disease, severe thyrotoxicosis.
- Magnesium deficiency.
- Multiple myeloma.
- Sarcoidosis.
What can influence the result?
- Drinking milk before the test may result in low PTH readings.
- An increase in PTH is observed during pregnancy and lactation.
- A false decrease in PTH is observed in milk-alkali syndrome (Burnett's disease).
- The administration of radioisotope drugs a week before the test distorts the test result.
- Medicines that increase PTH levels in the blood: phosphates, diuretics, lithium, rifampicin, furosemide, isoniazid, steroids, thiazide or anticonvulsants.
- Cimetidine and propanodol reduce PTH levels.
- PTH levels are subject to circadian rhythms and normally vary throughout the day, reaching a maximum at 2-4 p.m. and a basal value at 8 a.m.
Blood test for parathyroid hormone
Analysis for parathyroid hormone
is one of the most important in the list of examinations prescribed for suspected calcium metabolism disorders, including the development of osteoporosis.
Blood for parathyroid hormone is usually donated simultaneously with an analysis for ionized calcium, phosphorus, calcitonin
, since such a block of studies allows the endocrinologist to most fully assess the metabolic state. It is also highly advisable to immediately perform densitometry - a study of bone tissue density, which shows the likelihood of developing bone fractures.
Parathyroid hormone - analysis
, the quality of which varies greatly between different laboratories. Currently, the most common methods of performing a blood test for parathyroid hormone are enzyme immunoassay (the so-called 2nd generation method) and immunochemiluminescence (3rd generation method).
Most laboratories analyze parathyroid hormone using a 2nd generation method
, since equipment and reagents for enzyme-linked immunosorbent assay (ELISA) are inexpensive, you can even use domestically produced reagents. At the same time, the use of the ELISA method leads to a decrease in the accuracy of the analysis of parathyroid hormone in the blood and an increase in error.
The specialized laboratory of the North-Western Center for Endocrinology uses a 3rd generation automatic immunochemiluminescent analyzer DiaSorin Liaison XL (Italy) to perform analysis for parathyroid hormone.
– a device with exceptionally high analytical accuracy. In the work of endocrinologists at our center, the accuracy of a test such as a blood test for parathyroid hormone is the main diagnostic component, so we take issues of research quality very seriously. The specialized laboratory of the center NEVER performs parathyroid hormone analysis using the 2nd generation method and NEVER uses either domestic or Chinese reagents - only reagents made in Italy by the DiaSorin company.
If you are deciding where to donate parathyroid hormone
, and are not sure what tests should be taken additionally -
do the following blood test: parathyroid hormone and calcium (ionized is very desirable), phosphorus, calcitonin
. If you also donate your daily urine test for calcium, that will be simply wonderful; any endocrinologist will appreciate your erudition in matters of taking tests.
In the laboratory of the Endocrinology Center, the analysis for ionized calcium is carried out using an automatic biochemical analyzer Olympus AU-680 (Japan) - a high-performance, high-precision automatic machine capable of conducting up to 680 biochemical tests per hour! Combined with the high accuracy of parathyroid hormone and calcitonin tests, an accurate calcium test will provide optimal diagnostic results.
Where to get parathyroid hormone
The specialized laboratory of the North-Western Endocrinology Center takes tests for parathyroid hormone and calcium, phosphorus and calcitonin
, as well as receiving other analyzes (more than 1000 studies) at the following addresses in St. Petersburg and Vyborg:
— Petrograd branch of the endocrinology center
– center of St. Petersburg, 200 meters to the left on foot from the Gorkovskaya metro station, Kronverksky Prospekt, building 31. Branch opening hours: 7.30-20.00, seven days a week. Phone: 498-10-30. There is parking for cars.
— Primorsky branch of the endocrinology center
– Primorsky district of St. Petersburg, 250 meters to the right from the Begovaya metro station. Branch address: st. Savushkina, house 124, building 1. Branch opening hours: 7.00-20.00, seven days a week. Phone: 565-11-12. There is parking for cars.
— Vyborg branches of the Endocrinology Center:
- Vyborg, st. Gagarina, 27A, tel., from 7.30 to 20.00, seven days a week. There is parking available for cars.;
- Vyborg, Pobedy Ave., 27A, tel. (81378) 36-306, from 7.30 to 20.00, seven days a week. There is parking for cars.
The branches of the endocrinology center provide everything for the comfort of patients who came to take parathyroid hormone, calcium and other tests
– no queues, comfortable treatment rooms with comfortable chairs and cartoons for a positive attitude, air conditioning and deep air purification systems, modern vacuum blood collection systems.
You can receive the results of a blood test for parathyroid hormone and other indicators by email
immediately after they are completed. In the vast majority of cases, tests are performed within 1 day (often the test for parathyroid hormone and calcium is ready in the evening of the day the patient came for the test).
You can find a complete list of laboratory branches in the Leningrad region (the cities of Luga, Gatchina, Kingisepp, Svetogorsk) here.
If you are not yet sure where to take parathyroid hormone in St. Petersburg or the Leningrad region
– contact the Northwestern Endocrinology Center. You will be confident in the quality of the research and conduct it with comfort. It is important that in the same center you can get a consultation with an endocrinologist who has significant experience in treating disorders of parathyroid hormone production.
Parathyroid hormone is normal
When you donate blood in a specialized modern laboratory and receive the result of a test for parathyroid hormone, the norm is indicated on the laboratory form
immediately after your individual result.
Parathyroid hormone levels can be expressed in two different units of measurement - pg/ml and pmol/l. Recalculation between them is possible using the following formula:
parathyroid hormone level in pmol/l x 9.8 = parathyroid hormone level in pg/ml
Parathyroid hormone is normal
, when it fits within the boundaries specified as reference limits (standards).
This indicator is not dependent on gender - if you take a parathyroid hormone test, the norm for women will not differ from the norm for men
.
Parathyroid hormone
Parathyroid hormone (Parathormon, Parathyrin, PTH, Parathyroid hormone
,
PTH). Regulator of calcium and phosphorus metabolism.
Polypeptide hormone is one of the main regulators of calcium metabolism in the body. Produced by the parathyroid glands, the secretion of the hormone is influenced by changes in blood calcium levels. Reduces the excretion of calcium and increases the excretion of phosphorus from the body in the urine, acting on the kidney tubules. Promotes the flow of calcium and phosphate from bones into the blood, inhibiting the activity of osteoblasts; by activating osteocytes and osteoclasts, it helps to increase the pool of osteoclasts. Normal level changes are characterized by a circadian rhythm with maximum values at 14:00 - 16:00 and a decrease to the basal level at 8:00 am.
3 days before taking blood, it is necessary to avoid sports training, 24 hours before taking blood, avoid drinking alcohol, and 1 hour before taking blood, smoking. The patient should be completely at rest for 30 minutes before blood is drawn.
Biomaterial (blood from a vein) must be submitted for examination on an empty stomach. At least 8 hours should pass between the last meal and blood collection (preferably at least 12 hours). Juice, tea, coffee (especially with sugar) are not allowed. You can drink water.
Indications:
- Hypercalcemia.
- Hypocalcemia.
- Osteoporosis, cystic bone changes, pseudofractures of long bones, osteosclerosis of vertebral bodies.
- Urolithiasis (X-ray-positive stones).
- Suspicion of MEN 1,2 (multiple endocrine neoplasia types 1, 2).
- Diagnosis of neurofibromatosis.
Units:
pmol/l.
Alternative units of measurement:
pg/ml.
Unit conversion:
pg/ml x 0.105 ==> pmol/l.
Reference values:
1.45 - 10.41 pmol/l.
Increased parathyroid hormone levels
- Primary hyperparathyroidism (hyperplasia of the parathyroid glands, cancer of the parathyroid glands, multiple endocrine neoplasia types I and 2).
- Secondary hyperparathyroidism (chronic renal failure, hypovitaminosis D, rickets, ulcerative colitis, Crohn's disease).
- Tertiary hyperparathyroidism (autonomy).
- Zollinger-Ellison syndrome pseudohypoparathyroidism (peripheral resistance).
Decreased parathyroid hormone levels
- Primary hypoparathyroidism.
- Secondary hypoparathyroidism (complication of surgical treatment of thyroid diseases, hypomagnesemia, hypervitaminosis D, sarcoidosis).
- Active osteolysis.
Analysis cost: 3250 tenge
Analysis execution time: 1 working day. day
- ← previous
- View all news
- next →
Parathyroid hormone is elevated
Increased parathyroid hormone
is one of the most common reasons for patients to visit an endocrinologist - and rightly so, since high parathyroid hormone in the blood always means the presence of a disease that needs to be treated.
An increase in parathyroid hormone is referred to as “hyperparathyroidism”
. High parahormone is the main symptom of hyperparathyroidism. There are two main variants of this condition: primary hyperparathyroidism and secondary hyperparathyroidism. Tertiary hyperparathyroidism is also identified, which occurs in patients with chronic renal failure receiving hemodialysis - but we will not consider it in this article.
Primary hyperparathyroidism is a condition when at the same time parathyroid hormone and calcium are elevated in the blood
. Additional symptoms of primary hyperparathyroidism are a decrease in blood phosphorus (not found in all cases) and an increase in the level of calcium in daily urine (also not in all cases). High parathyroid hormone in the blood in primary hyperparathyroidism is associated with the formation of a parathyroid adenoma - usually a benign tumor that produces parathyroid hormone uncontrollably. The increase in parathyroid hormone in the blood directly depends on the size of the adenoma - the larger it is, the higher the parathyroid hormone is detected. If a patient has primary hyperparathyroidism and parathyroid hormone is elevated - treatment is always surgical - removal of the adenoma gives excellent results, returning all components of phosphorus-calcium metabolism to normal limits.
When a patient has high parathyroid hormone, the causes of this condition may be associated with vitamin D deficiency (we talked about this earlier). If parathyroid hormone is increased in the blood, and calcium is normal or decreased
– most likely, we are talking about secondary hyperparathyroidism, associated with a low amount of vitamin D entering the body. Treatment of such an increase in parathyroid hormone is always carried out in a conservative way, taking vitamin D and calcium supplements.
It is very important, when understanding the reasons why parathyroid hormone is elevated, not to confuse secondary hyperparathyroidism with primary hyperparathyroidism - otherwise the patient will undergo an absolutely unnecessary surgical intervention, the results of which, of course, will not please either the doctor or the patient.
Misdiagnosis of hyperparathyroidism
A lot of patients turn to an endocrinologist with suspected hyperparathyroidism, but not everyone receives this diagnosis. Why? Because suspicion of the disease often arises only on the basis of elevated levels of parathyroid hormone.
Meanwhile, the most common cause of mildly elevated parathyroid hormone levels is vitamin D deficiency, which is easy to recognize because calcium and phosphorus levels remain normal. Primary (or tertiary) hyperparathyroidism can only be diagnosed when PTH levels relative to calcium are inadequate.
Increased levels of parathyroid hormone in response to a stimulus (such as vitamin D deficiency) is a condition called secondary hyperparathyroidism. This is not an independent disease - it is a consequence.
A second cause of error is diagnosing hyperparathyroidism only on the basis of elevated calcium levels when PTH levels are low. The cause of this condition is usually tumor hypercalcemia (due to factors secreted by PTH-like tumors) or vitamin D overdose.
Elevated parathyroid hormone - how to cure, where to cure?
For an accurate diagnosis, all patients are recommended to contact specialized centers for endocrinology and endocrine surgery, such as the North-Western Center for Endocrinology in St. Petersburg, the Russian leader in the treatment of hyperparathyroidism.
In our center, we annually consult several thousand patients whom doctors (!) refer for surgery to remove a parathyroid adenoma, but in fact the patients only have a deficiency or insufficiency of vitamin D, which is easily eliminated by taking pills. True, there are also the opposite situations, when patients with large parathyroid adenomas come to us for surgery, for whom the diagnosis has not been established for several years, which simply leads to catastrophic consequences for the body. Every year, several patients with increased parathyroid hormone due to adenoma require resuscitation due to the threat of coma. There are situations when patients undergo surgery on the very first day, the adenoma is removed, and then a two to three month course of resuscitation and restorative treatment is required - that is how far the pathological process goes.
In the vast majority of cases, patients from other regions of Russia at the North-Western Endocrinology Center undergo surgical treatment free of charge, under the federal quota system or simply under a compulsory health insurance policy. Outpatient examinations are carried out for a fee, but their cost is rarely high.
So, if you have elevated parathyroid hormone, it is wiser to come for examination and treatment to a specialized endocrinology center
where you will receive qualified assistance.
Parathyroid hormone is low
The situation when parathyroid hormone is low
, occurs rarely in life. The main reason for a decrease in parathyroid hormone in the blood is a previous operation on the thyroid gland, during which the nearby small and not always clearly visible parathyroid glands were accidentally removed or deprived of blood supply.
Typically, when parathyroid hormone is low, symptoms
include numbness of the fingers and toes, the appearance of an unpleasant feeling of “goose bumps” on the skin, and the appearance of convulsive muscle contractions. The severity of these symptoms depends on the level of calcium in the blood - the lower they are, the worse the patient feels. In severe cases, generalized seizures may develop. If left untreated, the patient may die.
For a condition where parathyroid hormone is low, there is a special term - “hypoparathyroidism”. Many patients with a similar problem are trying to figure out how to increase parathyroid hormone
, however, whether an increase in parathyroid hormone will occur in the future or not after surgery usually depends only on how much injury was caused to the parathyroid glands. If restoration of the function of the parathyroid glands is possible, then it will certainly occur. However, during the entire time that parathyroid hormone is low, patients need to take vitamin D and calcium supplements - sometimes in quite large doses.
