High calcium levels and supplementation
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Anonymous
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My 80+ year old father has high serum calcium and has been referred to see an endocrinologist in a month or so.
His GP is now away on holidays for a few weeks. My mother has been giving him 1000mg of calcium and 2500IU Vit D daily for years. My question is should we continue this supplementation for the next month until he get back into see his doctor or sees the endo? Anyone with high CA or with hyperparathyroidism who has been given advice on taking or not taking supplements? From my reading it doesn't look like these supplements would cause the issue but it isn't clear from my google search if they should continue or be stopped. |
Anonymous
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No, stop the supplements now. He doesn't need excessive calcium.
He may have hyperparathyroidism |
Anonymous
| Stop the supplements right now. Retest. |
Anonymous
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TBH it’s not that much calcium and vitamin D, but if his calcium is high, he should stop. In any case, one should always stop ALL supplements for a couple weeks before blood work as some kinds can throw off blood work.
I had Hyperparathyroidism and parathyroid surgery. The surgery was a fantastic relief for my many Hyperparathyroidism symptoms. He should have his Calcium, PTH and Vitamin D tested, all from the same blood draw. Do it fasting, first thing in the AM, so what he eats doesn’t affect levels. Calcium should not be higher than 10 for someone his age, even though the lab results will state a “normal” range above 10. His PTH should be in the normal range *and* “appropriately normal,” which means inversely related to Calcium.If calcium is in the upper half of normal, PTH should be in the lower half of normal. So, a Calcium of 9.9 (high normal) with a PTH of 60 (high normal), together *aren’t normal* and are likely indicative of disease. Vitamin D should be above 30 without supplementing. TBH, even if his blood work is normal, I would do the CA/PTH/D test 3 times a few weeks apart each time. Calcium can fluctuate, and medications (gastric acid blockers, aromatase inhibitors and other meds) can alter calcium and vitamin D levels. And, to make things trickier, there are normo-calcemic and normo+hormonal variants of primary Hyperparathyroidism. Plus, one can have secondary Hyperparathyroidism, which is due to inadequate intake or absorption of either vitamin D or calcium. There is a very good Facebook group called “Hyperparathyroidism Support and Information” with a lot of guides about the illness, doctor recommendations, etc. Also, the website of the highest volume parathyroidectomy practice in the country - Norman Parathyroid Center - has a website with good explanations about the illness - parathyroid.com, and they have an app that you can input lab data. Many endocrinologists aren’t actually knowledgeable about Hyperparathyroidism. I had to beg my first endo to listen to my complaints and pay attention to a calcium of 10, even she did not immediately order a Calcium, PTH and Vitamin D panel. My second endo was even worse - kept telling me that I didn’t have Hyperparathyroidism even though I had an ultrasound with an identified parathyroid adenoma h the cause of Hyperparathyroidism). She also refused to refer me to a surgeon because she said that I couldn’t have surgery unless I had a calcium over 11, osteoporosis or kidney stones. This is a common misreading of Endocrine Association guidelines. I self-referred to a high volume endocrine surgeon who did a minimally invasive parathyroidectomy with intraoperative PTH monitoring. If your dad is going to consider surgery, it should only be with someone who is high volume - which is 50+ a year. Surgery is the only cure for Hyperparathyroidism, and although it is done on patients your dad’s age, one obviously has to weigh pros & cons of treatment vs. no treatment at that age. Having said that, getting diagnosed and having a parathyroidectomy is the single best health thing I’ve done for myself. I was sick for probably at least a decade - in that classic way that is non-specific enough to allow doctors to dismiss you. |
Anonymous
| What about albumin level? Isn’t that part of the equation when determining the true calcium level? |
Anonymous
| I also had hyperparathyroidism and surgery thru Johhs Hopkins (Sibley) with Dr. Aarti Mathur. Excellent surgeon. |
Anonymous
| ^^. Having said this I don't think they operate on the elderly as it is too high risk an operation. |
Anonymous
Your statement is wrong. Parathyroidectomy is absolutely done in the elderly, but, as with any parathyroidectomy, safety and efficacy depend on having the surgery done by a high volume surgeon who does minimally invasive surgery. Just before I had mine, my surgeon told me she operated on a 90 year old. Of course, any surgery decision depends on individual patient factors, but there is no general prohibition on parathyroidectomy for the elderly, and when done by a high volume surgeon with minimal invasive procedures, it is not a "high risk" operation. And, surgery is the only cure for hyperparathyroidism, which can cause kidney stones and osteoporosis and has many other symptoms, so just going untreated is not always an option. Here are some papers: 1) Parathyroidectomy is safe and improves symptoms in elderly patients with primary hyperparathyroidism (PHPT) by Michael J Stechman 1 , Mary Weisters, Fergus V Gleeson, Gregory P Sadler, Radu Mihai Endocrinol (Oxf) . 2009 Dec;71(6):787-91. doi: 10.1111/j.1365-2265.2009.03540.x. Epub 2009 Feb 16. https://pubmed.ncbi.nlm.nih.gov/19222492/ "Parathyroidectomy is safe in the elderly and is associated with a significant improvement in symptoms. As survival after operation is similar to younger patients, surgery should be considered in all elderly patients with PHPT." 2) Parathyroidectomy for primary hyperparathyroidism in the elderly: experience of a single endocrine surgery center ng Clin Exp Res . 2017 Feb;29(Suppl 1):15-21. doi: 10.1007/s40520-016-0666-7. Epub 2016 Nov 11. https://pubmed.ncbi.nlm.nih.gov/27837463/ This study compared outcomes in three groups - under 65, 65-74, and 75+ years old. There were no significant differences in outcomes (length of stay similar, no major complications in any group and no cases of mortality). The study concluded, "Parathyroidectomy is a safe and effective procedure to perform in elderly patients. Multiglandular disease was found to be more prevalent in older patients, but minimally invasive parathyroidectomy can be performed safely. Surgeons should consider parathyroidectomy in patients with primary hyperparathyroidism regardless of age." 3) Asian J Surg 2021 Jan;44(1):321-328. doi: 10.1016/j.asjsur.2020.07.022. Epub 2020 Sep 3. Being elderly is not a contraindication of parathyroidectomy for renal hyperparathyroidism and chronic kidney disease-mineral and bone disorder https://pubmed.ncbi.nlm.nih.gov/32891512/ Both groups exhibited significant postoperative improvement on the BMD results. The recovery potential of the elderly was not lower than the younger group. High success rate and none of persistent vocal palsy, hypocalcemia or any sequela were also observed in the elderly. Conclusions: Parathyroidectomy is an effective and safe intervention for the CKD-MBD in the elderly. There are many other studies like this. |
Anonymous
The older method for assessing for hyperparathyroidism was to incorporate the albumin level and "correct" the calcium level. Also, ionized calcium levels were used. This has not been my experience today with my endocrinologist nor my endocrine surgeon. Both looked a serum calcium and didn't need albumin or ionized calcium to diagnose. I had normo-hormonal PHPT. I did not have any complicating diagnostic factors like kidney disease or stomach absorption problems. Maybe in more complicated cases it is used, but my impression is not even in those. |
Anonymous
| How high is his serum calcium? Does he have any other medical conditions? |
Anonymous
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Op here.
He had some blood work and his calcium was high so the PCP ordered more tests (he doesn't know what, just that he had to go back for more blood work). He thought it was just to double check the calcium level but he said there were a few things checked off on the requisition. After that second batch, the PCP called and told him his calcium was high and he needed to see an endocrinologist. Then PCP went on vacation! So I don't have any more information about what else was tested or what the actual levels were. We won't get any additional information until mid January when his PCP is back in office and we can make an appointment. |
Anonymous
Op here. He has Parkinsons (now about stage 3) but is otherwise healthy. |
Anonymous
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I used to take Mg supplement until I figured out it was causing my serum Ca to rise.
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Anonymous
There is a relationship between calcium and Parkinson’s. You should do some reading. Go ahead and make an endocrinology appointment now if the PCP already said to. It can take months to get in and many endocrinologists require a formal referral. Would highly recommend you see an endocrinologist experienced in Hyperparathyroidism as many are not and failure to diagnose and offer treatment is more frequent than you would think. If he had bloodwork at a Quest or LabCorp attached to the doctors office, you should be able to see the results in the lab company portal and the doctors portal even with the doctor being away. And, just to prepare you - there is something called humoral hypercalcemia of malignancy. It is when calcium goes very high (usually over 11) and happens in Stage 4 cancer when cancer is affecting bones. If your dad is otherwise healthy, HHM would be extremely unlikely, but a provider may mention that possibility and want to rule it out by asking more Qs and running more tests. One test is blood work for PTHrP, which is different from PTH and only rises in late cancer, but it can mimic PTH and cause an increase in calcium. In HHM, Ca is high, PTH is usually low (I think) and PTHrP is elevated. |
Anonymous
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I had high calcium and it wasn't a parathyroid thing -- There were a ton of other tests to run and rule out various forms of cancer -- but it turns out I have sarcoidosis, which is fairly benign, but I cannot take vitamin D or calcium supplements.
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