Q&A with Dr Norman

To date we have produced a total of six podcasts to help educate and advocate for improvement in diagnosis and standards for surgical treatment of primary hyperparathyroid disease. Our listeners have been invited to submit questions that relate to these podcasts, so they can be answered by our guests –  expert surgeons from the Norman Parathyroid Center.  

Dr. Jim Norman

Below are a few questions submitted that relate to interviews conducted with NPC’s founder Dr. Jim Norman, MD, FACS, FACE. He is recognized as one of world’s foremost experts on parathyroid disease. Dr Norman is a Fellow of the American College of Surgeons (FACS) and also a Fellow of the American College of Endocrinology (FACE). He is recognized as the inventor of minimally invasive radioguided parathyroid surgery in the mid 1990s, and is credited with dramatically changing the way parathyroid surgery is performed. Dr Norman and his team have performed over 25,000 parathyroid operations.

Question: “I understand from listening to your podcast that normal serum calcium levels should be adjusted based on age. Should normal ionized calcium levels be adjusted for age as well?”

Dr. Norman: “Ionized calcium does change with age, but not nearly as much as serum calcium.”

Question: “This is a clarification question on the urinary calcium: in one of your podcast you said it doesn’t matter whether it is high or low, that it isn’t a good test. I thought that indeed it was used to help with the people who were harder to diagnose because of “normal” values, but still presenting with symptoms. The kidney will filter the extra calcium load and keep the serum from getting “too high” and the pth will stay in normal range, but the urine will have a good amount of calcium. Can you please clarify?”

Dr. Norman:  “There a few times when a 24 hour urine test can be helpful, but they are few and far behind. It is MUCH more common for the 24 hour urine calcium to provide WRONG information to the doctor and potentially make a wrong diagnosis of FHH than it is for the 24 hour urine calcium to help. It almost never helps, it usually causes tremendous problems and confusion. As a general rule, therefore, it should not be done. It is more harmful than good by a 20 to 1 margin.”

Question:  “When they found my parathyroid adenoma, my GP tried to put me on high doses of vitamin D because I was low from the hyperparathyroidism. My Endocrinologist told me not to take it. My surgeon told me to take some before surgery to force my calcium level up so they could see it fall during adenoma removal. I was stuck in the middle wondering which doctor’s advice to take and finally sided with the surgeon pre surgery and the Endocrinologist post surgery. Do you have a word of advice for our listener?”

Dr. Norman: “Your GP is making a mistake because he doesn’t understand—he is treating a number and not understanding what caused that number to be low. Your endocrinologist is correct, taking vitamin D when your calcium is high will not help, can be very dangerous, and typically (50% of the time) makes people feel worse and their symptoms worse.  Your surgeon has no clue. He/she has no idea what they are talking about—nobody measures calcium during surgery. This one is completely inexcusable and suggests you may want to look for a surgeon who understands this disease better. A bad outcome is much more common in surgeons who use measures of PTH (or calcium?) in the operating room—they remove normal glands more than 10 times more frequently.”

Thank you Dr. Norman for answering our listeners’ questions. If you would like to submit your questions after you’ve listened to our podcasts, email us at parathyroidpeeps@gmail.com or leave a comment on our FB page.

The Parathyroid Peeps

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