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Family Medicine  (Expert Forum)
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PTH Returns
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD Boston - MA
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MedHelp Member's Question

PTH Returns

by gienka, Jan 08, 2006 12:00AM
Hellow' I'm wondering if My PTH is gone forever because it's been suppressed for so Long. I had thyroid removed four years ago. Was put on Calcitriol,Calcium at that time two years after surgery discovered Low B-12 and PTH of 24 started B-12 shots. I am now four years past surgery and wondering if I should try to convince a Dr it might be OK to check PTH and maybe wean off of calcitriol. In the last few months I have had low magnesium 1.7] phosphorus4.9] [Calcium varies from 8.6 to 10.5] Albumin 4.1] [Creatinine 0.9] Vit D'25- hydroxy slightly low] I have felt like this is a problem for me and two years ago I kept telling them I felt better if I skipped the calcitriol. I maybe should of weaned myself off at that time I'm worried it's two late now and I'm very concerned about trying to do it without labs that's the only reason it's not been attempted yet. What do I need to say to get some help.
Doctor's Answer

by Kevin Pho, MD, Jan 09, 2006 12:00AM
I would express your concerns to your physician or endocrinologist.  A complication of thyroid surgery is inadvertent removal of the parathyroid glands.  



A PTH can certainly be check to see if this is the cause.  



If there is consideration for removing the calcitrol, you should certainly do it under the observation of a physician as well as monitoring labs.



This option can be discussed with your personal physician.



Followup with your personal physician is essential.



This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.



Kevin, M.D.

kevinmd_b
Member Comments (6)

by gienka, Jan 08, 2006 12:00AM
Sorry I forgot to add that I had to drop dairy products from my diet two years ago. My calcium got so high I stopped all meds for two weeks after which my calcium was 9.3 I have not had dairy product's since. When I mention I want to go off of calcitriol I always hear you can't do that. And maybe I can't at this point but I don't understand is there something they know that I'm not figuring out. Current meds are Calcitriol .25] [synthroid 1.75] [mag oxide 400 x2]  [calcium 500x6] all daily.[ B-12 shots 1000mcg monthly]. I am putting dairy back in my life one glass a week to start I'm concerned if I end up in an er some where they won't check PTH because it's been four years and it's logical to assume I lost all function. Any Ideas would be helpful. I don't think they believe me when I try to tell them. Even though I have the labs from two years ago have you ever had anyone with PTH function that long after surgery.Thanks

by B_Johnson, Jan 09, 2006 12:00AM
To: Gienka
Iatrogenic Hypoparathyroidism (mistakenly resecting part of the parathyroid) as a complication of thyroidectomy occurs often.



However judging from your synthroid dose i assume that you only lost part of your thyroid and thus would have only risked sacrificing the part of your parathyroid in that area.



Your PTH appears to be in the low end of normal so you definetly have some permanant parathyroid function remaining.  



Do you understand the function of these hormones?



PTH is produced in the parathyroids and increases blood calcium levels when they are low by breaking it down from your bones.



Calcitonin is produced by the thyroid and is the inhibitor of PTH.



The reason your doctor may have put you on this regimen is because you may have lost calcitonin producing cells in your thyroidectomy.  Thus now your PTH can run rampant without being inhibited.



One option to control this is to take replacement calcitonin like your replacement T4 (synthroid).  The other is to take Calcitrol (vitamin D) and calcium to prevent your blood calcium from dropping low which would stimulate more PTH to be produced.



Especially in older age and if you are female, bone loss is a concern and the regimen you are on is similar to that of someone who suffers from osteoporosis. PTH can exacerbate osteoporosis and bone loss thru the mechanism described above.



In response to concerns about your calcium levels, understand that blood calcium must rise above 14mg/dL before it is a major physiologic concern.  As long as you increase your water intake, you have a less likelihood of developing kidney stones as a result of the hypercalcemia, which is probably the more pertinent concern at this time.



Why was your thyroid resected?  If tumor, what type?



Do you feel that you have any symptoms as a result of the increase in calcium?  What are these symptoms?



Please consult with your physician before making any changes to your medications.



-Dr. J

by B_Johnson, Jan 09, 2006 12:00AM
To: Gienka
My mistake.  I thought you were on 0.025 synthroid.  You did obviously lose almost all of your thyroid from the surgery.  The fact that you were producing PTH at the low end of normal is a sign that your parathyroid function was preserved.  You will continue to produce PTH for the rest of your life.  The Calcium as mentioned before is to keep this hormone in check and from depleting your bones. The calcitrol is activated vit-D which must be present in order for you to absorb inorganic calcium from food in your small intestine.



...just trying to answer your questions more directly



-Dr. J

by gienka, Jan 12, 2006 12:00AM
Thank You,  Though I Think I need to clarify.  I had a complete Thyroid removal for Papillary Cancer in Dec 2001. Calcium dropped to 6.6 within 2 days so I was put on mends for hypoparathyroidism.  The following 2 years I had muscle spasms also occasional bone pain in my lower legs. When I started b-12 shots two years after surgery the pain and spasms went away that's also when my calcium got high. It was high enough for two weeks I don't even remember that two weeks.  I slept for that two weeks and dropped the calcitriol and calcium. After which I was seen and told to continue treatment In order to make it work without being sick I had to drop dairy products. For the last two years I have had no dairy and been taking meds for hypoparathyroidism. I have had I-131 for the second time a month ago and currently have very minor spasms and some palpitations though I think these are due to the increase in synthroid I seem to get this every time there is a change in synthroid. what are your thoughts as far as a possibility of regaining parathyroid function and would I be better off  regaining some function or keeping it suppressed. what are the  positives and or negatives for each option And thak you for taking the time to anser it's been very helpful.

by slk03, Mar 19, 2006 12:00AM
I HAVE BEEN SICK FOR ABOUT 7 MONTHS I HAVE HAD NUMBNESS AND TINGLING IN MY FACE AND ARMS AND FEET. AND I HAVE HAD CRAMPS IN MY HANDS SO BAD AND PAIN IN MY UPPER BACK. I HAD MY THYROID TAKEN OUT 2 YEARS AGO. I HAVE BEEN HAVING MY HEART RACING TO. I WAS TAKEN IN TO THE HOSPITAL THEY TOOK ALL KIND OF BLOOD WORK AND HEART TESTS. MY HEART IS FINE. MY MAGNESIUM WAS LOW MY CALCIUM WAS LOW AND MY PTH WAS LOW. SO THEY GAVE ME MAGNESIUM IN MY I.V. AND ARE GIVING ME VITAMIN