Doc: Tests don’t support parathyroid disease diagnosis
Dear Dr. Roach: I’m a 78-year-old woman with many symptoms of parathyroid disease (chronic fatigue, feel “ill,” need naps, less concentration, memory “hesitation,” blurred vision), yet the blood tests are not at the confirmation level. My blood tests showed: PTH (parathyroid hormone) 71, calcium 9.5, calcium (ionized) 3.94, vitamin D 29. I have just started a vitamin D regimen. I am feeling dreadful, and am unsure how to proceed.
Dear J.D.: The parathyroid gland controls many aspects of calcium metabolism. Elevations in parathyroid hormone, usually caused by a benign tumor of the gland (which sits on top of the thyroid gland in the neck, hence its name) trigger a rise in body calcium. Normal calcium levels depend on age, but usually are below 10.2. Ionized calcium levels, the biologically active kind, normally are 4.5-5.4. These should be high in people with elevated PTH: Your level is slightly below normal (at least according to my reference laboratory). Vitamin D also is important in calcium regulation, and the interaction between the two is complex. A high PTH level commonly causes low vitamin D. However, long-term, persistent low vitamin D can cause PTH levels to become higher than expected.
The lab tests you have are most consistent with low vitamin D, not with high parathyroid levels. The symptoms you describe are nonspecific. Low vitamin D can cause fatigue and poor concentration: I certainly hope the regimen you started will have you feeling back to normal by the time this is published. However, if you still are not feeling like yourself, you and your doctor should start at square one and review your entire history, do a careful physical exam, review your medications and lab tests, and decide how to proceed. There are many possible causes.
Dear Dr. Roach: I have been told to keep my total cholesterol under 200. Without taking a statin drug, my total cholesterol averages about 220. My HDL cholesterol has been in the 90s for 15 straight years. My triglycerides average about 50. LDL cholesterol averages 120. Should I be taking a statin drug? Is HDL over 90 too high?
Dear J.B.: People with known coronary artery disease (blockages in the arteries to the heart) should be on a statin drug unless they can’t take one, regardless of their cholesterol level. Otherwise, I always believe in taking a holistic approach before recommending a statin drug. That means looking at overall risk, not only using cholesterol numbers, but also looking at other risk factors, especially smoking history, blood pressure, family history and sometimes other blood tests, such as CRP. Then, I recommend changes in diet and exercise. Often this improves cardiac risk so much that a statin is not necessary. There are other changes that a person can make, including stress reduction, that may reduce the risk of developing heart disease.
HDL is protective against coronary disease, so a low HDL number is a risk, and a high HDL helps reduce risk (think “H” for “Healthy”). An HDL of 90 is really high, so it would be an unusual situation for me to recommend a statin drug.
Email questions to ToYourGoodHealth@med.cornell.edu.