I didn't read the beginning of the thread but I know there is a link between thyroid disease and secondary hyperparathyroidism. It is vital that calcium is in range (Parathyroid hormone can be normal and calcium only slighty out of range for hyperparathyroidism to be present) this is the best site to learn about this problem..... Lots of doctors dismiss slightly raised calcium levels - also Vit D can be depressed to slow down calcium absorbtion - supplementation with Vit D CAN be dangerous in some cases....
parathyroid.com/hyperparath... (to convert from UK calcium level of 2.43 divide by .2495) normal people have range of 9 anything above that is suspicious and should be checked out by our doctor.
I have seen endos all of whom have told me I haven't got hyper parathyroidism, having ruled out osteo arthritis and osteporsis from the menopause I now know I have hyper parathyroidism because osteoporsis doesn't cause pain in legs and hip as is the case with osteoporosis caused by hyper parathyroidism.
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.
About 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 below 25, 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 parathyroid tumor.
About 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.