In many cases the diagnosis is straightforward.
If your calcium is higher than normal and your parathyroid hormone is also higher than normal, then almost certainly and regardless of symptoms, you have hyperparathyroidism.
You should discuss surgery with us because in most cases it will be beneficial.
If you have many of the symptoms of primary hyperparathyroidism but your blood tests are not abnormal (not showing hyperparathyroidism), then you don’t have it, and there is another explanation for your symptoms. We cannot help you.
Some patients with higher than normal calcium and normal PTH (usually PTH in the upper part of normal range) do also have ( normo-hormonal) Hyperparathyroidism.
Some patients with higher than normal PTH and normal Calcium – (in the upper normal range)- also have (normo-calcaemic) Hyperparathyroidism.
Some patients with borderline high calcium and borderline high PTH also have primary hyperparathyroidism, even if both are within the normal range.
We recommend you discuss your diagnosis with us and we will often recommend surgery for you.
Note if your PTH is elevated but your calcium is normal and is 2.45 or below, almost certainly you do not have primary hyperparathyroidism and will not benefit from surgery. In these cases elevated PTH may be Secondary Hyperparathyroidism due to chronic Vitamin D deficiency, chronic low calcium, malabsorption, renal impairment or other explanations. Adequate replacement of calcium and Vitamin D for 12-18 months will often reduce PTH levels without leading to high calcium.
FHH ( Familial Hypocalciuric Hpercalcaemia) is rare and is usually suggested in patients who know they have a family history of this, in those who have had four “normal “ parathyroid glands found at surgery or patients with mildly abnormal blood tests and very low urine calcium excretion. Note that far more patients with low urine calcium or calcium to creatinine excretion ratios have primary hyperparathyroidism rather than FHH.
