Thyroid Cancer / Nodules & Hyperthyroidism Expert Forum
Single Right-Sided Parathyroid Adenoma
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Single Right-Sided Parathyroid Adenoma

Dr. Lupo, I have been diagnosed with a single right sided parathyroid adenoma. YET, all my calcium levels have been very normal including a 24 hour urine collection.  My PTH remains high (90-115) and my vitamin D (25-OH) is low.  This D Level was brought up to 59 with 50,000 units of Vitamin D for 2 weeks  but is slowly coming back down as I am not on D anymore.  My PTH remains high and even went higher while on the Vitamin D.

I have been to three different doctors and none of them are up on parathyroid disease unless calcium levels are high which mine are not.  

Have you seen cases like mine with normal calcium levels, high PTH and a single parathyroid adenoma seen on a 4D CT scan, also seen on a Setamibi scan and seen on an Ultrasound.   Should this tumor be removed in the setting of normal calcium levels?  I have read about the 15 minute mini surgery that only a handful of surgeons in the U.S. do.  What are your thoughts on this? Can high PTH levels cause symptoms? Can this tumor cause symptoms?

Of note: First CT scan did show a 8mm paratracheal lymph node on the right side but this did not appear on the repeat 4D CT scan.  The parathyroid adenoma also appeared on the Sestamibi scan and also on the ultrasound of the neck.   Two thyroid nodules appeared on the right also on the ultrasound.  

Thank you, Dr. Lupo for your time.  

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4D CT -- that is advanced technology -- you must be in a university setting or large city....

Anyway, would check ionized calcium as sometimes the regular calcium can be normal.  If that is also normal, then I agree that you likely have early primary hyperparathyroidism which can cause low 25-OH-D levels.  Usually with true secondary hyperpara (which the docs likely currently think is going on - b/c of confusion in interpreting the Vit D) the calcium levels are on the low side.  Symptoms are thought to be caused by the calcium.

Check out parathyroid.com -- there is lots of info there.  

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Mark Lupo, M.D.Blank
Thyroid & Endocrine Center of Florida
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