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Dr.Amita
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Why is important to have ones vitamin D level up before

Customer Question

Why is important to have ones vitamin D level up before having parathyroid surgery?
Submitted: 1 year ago.
Category: Medical
Expert:  Dr.Amita replied 1 year ago.

Hello

I am Dr.Amita and I would be assisting you with your concern today.

Can you tell me what surgery are you going to have?

Is it for removal of parathyroid?

What underlying problem you have?

Thanks

Customer: replied 1 year ago.
They found a growth on one of the parathyroid glands. My vitamin D level is currently undetectable. My endrocronologist says no surgeon will remove the parathyroid gland with out my vitamin d level raised to 25 or greater. Why? I have read that because if the tumor the level won't raise. Also my PTH level is 387.2 and my calcium level is 10.6.
Customer: replied 1 year ago.
Underlying problems are fatigue,trouble sleeping, acid reflux and more.
Expert:  Dr.Amita replied 1 year ago.

If we take a simplistic view you are right.

Elevated PTH and serum calcium levels indicate primary hyperparathyroidism.

Vitamin D levels are depressed in patients with primary hyperparathyroidism and may not elevate until the cause is eliminated.

In that case it would not be advisable to load you with high dose of Vitamin D before removal of parathyroid.

But there are other confounding factors.

Certain drugs like thiazide diuretics and lithium may also cause a picture like primary hyperparathyroidism and this confounding factor needs to be considered.

A condition known as familial hypocalciuric hypercalcemia (FHH) can mimic primary hyperparathyroidism and should be eliminated before considering surgery because FHH does not need surgical treatment.

A 24-hour urine calcium and creatinine test are done to rule out this condition.

National Institutes of Health (NIH) consensus panel has come up with the guidelines for recommending surgery in patients who are asymptomatic.

According to these guidelines following set of patients may be offered surgery

  • Serum calcium level more than 1.0 mg/dL above the upper limit of normal

  • Marked hypercalciuria (> 400 mg/day) or renal stones

  • Creatinine clearance less than 30% of normal

  • Marked bone density reduction with a T-score lower than 2.5 at any site

  • Age less than 50 years (if the problem is left untreated, many of these younger patients eventually develop complications of primary hyperparathyroidism)

  • A patient who requests surgery or a patient for whom surveillance and follow-up are difficult or impossible.

Patients with minor symptoms have to depend upon the experience of the surgeon in determining if surgery would eventually be beneficial.

Having said that I would recommend that you seek another opinion and have a complete workup before deciding about surgical treatment.

Customer: replied 1 year ago.
I didn't get my question answered. I already know I have hyperparathyroidism and not FHH. I need the surgery. I want to know what happens or the dangers of doing the surgery before vitamin D levels get elevated. What are the danger? Why won't surgeons do the surgery and the work on getting the vitamin D level raised?
im not satisfied with the response I received already.
Expert:  Dr.Amita replied 1 year ago.

I am sorry if I was not clear.

The issue here is what type of hyperparathyroidism you have.Is it primary hyperparathyroidism or secondary.

In case of secondary hyperparathyroidism vit d levels have to be elevated by supplementation and parathyroid levels need to be checked again.

NIH guidelines clearly mention that serum calcium levels have to be raised by more than 1.0mg/dl before surgery is to be considered.That is not the case with you.

Therefore surgeon has to consider whether your problem is due to primary hyperparathyroidism or secondary hyperparathyroidism.

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