Hyperparathyroidism

[Francesbarbara]

For many years I have had a slight raise in calcium level in bloods. No treatment necessary as long as I don't get a 'spike' Now have steroid and Methotrexate for possible PMR or late onset arthritis. Have been prescribed Vit D but no calcium supplement which most people get. Presume this is because of my raised calcium level?

[PMRpro Ambassador]

I imagine so. Do you actually have a diagnosis of hyperparathyroidism?

[Francesbarbara in reply to PMRpro]

Yes, diagnosis is 'Mild hyperparathyroidism' No action required apart from re-checking calcium.

[PMRpro Ambassador in reply to Francesbarbara]

Does the endocrinologist (I assume) know you are now also on steroids? Have you been assessed for osteoporosis because of the hyperparathyroidism?

[Francesbarbara in reply to PMRpro]

Because my calcium level has been raised for a number of years I was referred to a geriatrician (surprised me ) and it was his suggestion that a parathyroid hormone level was done. He also said that the calcium and albumin test should be repeated at the same time. He wrote to my GP afterwards saying that the blood test showed that the parathyroid hormone was 'marginally raised' and no further investigations were needed, other than Vit D level checking, as that was returned as 'slightly insufficient' I was prescribed Vit D tablets - one per day and that was that. My GP knows I am on Steroids and Metho. as she referred me to the Consultant Rheumy in the first place. I have not been assessed for osteoporosis as I wanted a Dexa scan first and that was refused. GP wanted me on Alendronic acid as routine and I said I was not keen, especially if I had no scan to ascertain the state of my bones first. I was told that even if a Dexa scan was done and was found to be excellent, it would make no difference to the decision to give Alendronic. I thought that was ridiculous but kept that to myself.

[PMRpro Ambassador in reply to Francesbarbara]

That isn't true - if the dexascan is normal then vit D and calcium supplements are the first approach - my bone density stayed the same on just that for over 7 years. Unfortunately I took my eye of the ball: due to a combination of circumstances I wasn't taking the calcium last year and also not having anything like the exercise I had before and although my spinal bone density has barely changed, the hip has deteriorated quite a bit. However - with the hyperparathyroidism they need to know if that has affected the bone density. What are they going to do? Force it down your throat? How silly.

[Francesbarbara in reply to PMRpro]

I think I'll 'phone specialist nurse at Rheumatology on Monday (they are usually VG and work closely with the consultant in a fast track clinic) I'll see what response I get about calcium supplement in my case and also ask her about Dexa scan possibility. Thank you so much for writing.

[Parami]

Sorry, but there's no such thing as mild hyperparathyroidism (HPT), you either have it or you don't, and treatment is usually surgery. Untreated, you can get osteoporosis, among other nasties. In my case, I have osteoporosis; I can't take calcium but, after having a Dexa scan, am on alendronic acid. There are NICE guidelines for treating HPT and a very informative website - hyperparathyroiduk.com for more details.

[Francesbarbara in reply to Parami]

This is tricky, as it was explained to me that as I have had this marginally raised calcium for years, they would do nothing, as long as it remained low. Because I am completely asymptomatic, they wouldn't think of surgery. Very tempting to accept that decision at aged 79. I suppose as long as it is checked regularly I have to accept what they say but I'll certainly be pestering them for tests.

[Parami in reply to Francesbarbara]

Yes, do make sure you have the tests at least. Take care.