Unmasking Normocalcemic Hyperparathyroidism
By: Jamie Mitchell, Kevin Parrack, James Norman, Deva Boone, Douglas Politz, Jose Lopez
Doctors have long used blood calcium levels as a guide for deciding when patients with primary hyperparathyroidism should have surgery. Current guidelines suggest surgery if calcium levels rise more than 1 mg/dL above normal. But new research from over 20,000 patients challenges this idea.
The study compared two large groups of patients: one with calcium levels just slightly elevated (10.0–11.0 mg/dL) and another with higher levels (>11.0 mg/dL). The results were surprising: patients in both groups had nearly identical symptoms and disease severity.
Fatigue: 72% in both groups
Bone pain: about 50% in both groups
Sleep problems: 65–68%
Osteoporosis: 40%
Kidney stones: around 1 in 5
High blood pressure: about half of all patients
In other words, patients with “mild” calcium elevations were just as sick and symptomatic as those with higher levels. The findings show that waiting for calcium to rise above a certain threshold may delay treatment without improving outcomes.
Why it matters:
This study suggests that calcium levels alone shouldn’t decide whether a patient gets surgery for primary hyperparathyroidism. Instead, doctors should consider the full picture—symptoms, bone health, kidney function, and quality of life. For patients, it means that even if your calcium doesn’t seem “that high,” surgery may still be the right choice to restore health.
