Patients diagnosed with primary hyperparathyroid disease are all too familiar with our doctors telling us that our calcium is not high enough to do anything about it. We are often told  that the appropriate course of action is to simply “wait and see” until our calcium is  over 11 and/or our symptoms progress. As a result, patients suffer needlessly from symptoms that significantly impact our quality of life. We are often ignored until our health deteriorates to the point of developing   kidney stones or irreversible damage is done to our bones. In severe cases, the disease can cause damage to the heart valves and increases the risk for heart attack. The hypothesis that “mild” hypercalcemia equates to mild hyperparathyroidism and thus the patients is not at great risk,  is common in the literature and in clinical practice, as experienced by patients like us, apparently despite a lack of evidence.

A recently published scholarly review entitled, Concentration of serum calcium is not correlated with symptoms or severity of primary hyperparathyroidism: An examination of 20,081 consecutive adults, shows conclusively that the concentration of serum calcium, whether between 10 and 11 mg/dL or higher than 11 mg/dL, is unrelated to number and type of symptoms and disease severity in primary hyperparathyroidism. In other words,  people with just “mildly high” calcium levels feel  just as bad and have just as many health issues as those with higher calcium levels! 

The graph below created from the data of 20,000 + patients from the Norman Parathyroid Center is included in the paper and was posted on the Parathyroid Disease Awareness Group: Norman Parathyroid Center’s Facebook page in April 2016.

People with calcium levels that were just above normal had as many symptoms and complications from the disease as those with very high calcium levels.  – Dr. Deva Boone

What is extremely important for the health care community to recognize and fully embrace (and for patient advocates to shout from the rooftops) is that there is no evidence to continue to support a serum calcium threshold in the parathyroidectomy guidelines.

You can read and learn more by linking to the references below.

References:  

Parathyroid Disease Support and Awareness: Norman Parathyroid Center

•  Facebook Page
•  Website

Concentration of serum calcium is not correlated with symptoms or severity of primary hyperparathyroidism: An examination of 20,081 consecutive adults

Surgery January 2017 Volume 161, Issue 1, Pages 98–106 https://authors.elsevier.com/a/1UDPM90L~Y6h8

• Societal paper for the American Association of Endocrine Surgery. Abstract presented at the American Association of Endocrine Surgery 37th annual meeting, April 12, 2016, Baltimore, MD.
• Boone, MD, , Douglas Politz, MD, Jose Lopez, MD, Jamie Mitchell, MD, Kevin Parrack, MD, James Norman, MD – Norman Parathyroid Center, Tampa, FL.  Accepted 22 September 2016, Available online 15 November 2016