Calcium and hyperparathyroidism

DEAR DR. ROACH >>

After dealing with hyperparathyroidism for over a decade, I became an administrator of a support group for the disease. Many of our members have difficulties getting a diagnosis and a subsequent referral to a surgeon. Can you discuss why you think this is? Shouldn’t a PTH lab be ordered when a patient’s serum calcium is flagged as high?

DEAR J.C.C. >> The four parathyroid glands sit on top of the thyroid and make a hormone called parathyroid hormone, commonly abbreviated as PTH and unrelated to thyroid hormone. Having elevated PTH levels is called hyperparathyroidism, which can be due to one of several causes. Most commonly it’s due to a benign tumor in one of the parathyroid glands. Most people are diagnosed when a routine blood draw shows elevated levels of calcium. This should be repeated, and if still high, a PTH level absolutely should be ordered. A diagnosis of primary hyperparathyroidism is very likely when there is a combination of high calcium and high or normal PTH level. In this case, “normal” isn’t normal, because if the calcium is high, the PTH level should be low.

The symptoms of hyperparathyroidism can be subtle. Some people have none, while others can have kidney stones and osteoporosis. Medical conditions like these prompt a recommendation for surgical removal, which is the definitive treatment. People with very high calcium levels or kidney disease, or those younger than 50 at presentation are recommended for surgery even if there aren’t symptoms.

Commonly, I find that for people with vague symptoms, they (and their doctors) might have attributed their experience to getting older. Loss of appetite, some nausea after eating or a little constipation are common. Bone pain and muscle weakness might show up on careful questioning. Neurological symptoms such as poor concentration and fatigue are likewise common. None of these is specific, but when a person with a diagnosis of hyperthyroidism has these vague symptoms, a wise doctor discusses surgery as well. Surgical treatment tends to better improve a person’s quality of life compared with medication.

I am 90 years old. Besides prescription meds, I take cranberry, an eye-health multivitamin, zinc with echinacea, magnesium and vitamin D3 drops. Are these actually helpful for good health?

— B.H.

DEAR DR. ROACH >>

DEAR B.H. >> Well, a lot of people think so, and are convinced that they help them stay healthy. However, the published data is not so clear.

Cranberry extract is mostly used by people to try to prevent urinary tract infections. Although they are safe and there have been some trials that show benefit, there’s been no strong evidence that they are effective at either prevention or treatment of urine infections after review of all trials.

The AREDS vitamins slow progression in people with age-related macular degeneration, but are of very little (if any) benefit for people who have not been diagnosed with this condition.

Both echinacea and zinc are used to treat, and sometimes to prevent, colds or other respiratory viruses. The data suggests limited or no benefit. Zinc used nasally can cause permanent loss of sense of smell.

Magnesium is a critical element for many body processes, and I have recommended it for some conditions, such as migraine, where there is some evidence of benefit. Once again, it is safe in reasonable doses.

Vitamin D is complex, but a recent large study found most people do not benefit from supplemental vitamin D. There are many exceptions to this, such as people with osteoporosis or poor absorption.