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Your Blood Test Came Back Abnormal. What Does It Mean?
A routine blood panel showed that your calcium level is above normal. Your doctor flagged it and may have ordered a repeat test, which came back high again. Now you’re wondering: is this serious? What’s causing it?
Hypercalcemia (the medical term for elevated calcium in the blood) has many potential causes, but the most common cause in otherwise healthy adults is a condition called primary hyperparathyroidism. And the most important thing to know is this: it is almost always curable with a straightforward, minimally invasive surgical procedure.
The Parathyroid Glands: Tiny but Powerful
Most people have never heard of their parathyroid glands, and for good reason. They are four rice-grain-sized glands tucked behind the thyroid in the neck, and their entire job is to regulate calcium levels in the blood by producing parathyroid hormone (PTH).
When everything is working normally, PTH keeps calcium in a tight range. But when one or more parathyroid glands develops a benign tumor (called an adenoma), it starts overproducing PTH regardless of how much calcium is already in the blood. The result: chronically elevated calcium.
Primary Hyperparathyroidism: A Condition That’s Often Missed for Years
Primary hyperparathyroidism is the most common cause of hypercalcemia in outpatients. It affects approximately 1 in 500 people, predominantly women over age 50, but it is frequently under-recognized because many patients have subtle or vague symptoms that are easy to attribute to other causes:
- Persistent fatigue or low energy
- Bone pain or joint aches
- Kidney stones (recurring episodes)
- Difficulty concentrating, brain fog, or mild depression
- Frequent urination or excessive thirst
- Osteoporosis or low bone density
- Abdominal discomfort, constipation, or nausea
Many patients report feeling “off” for years before their elevated calcium was identified. Once diagnosed and treated, the improvement in quality of life can be significant.
How Is the Diagnosis Confirmed?
The diagnosis of primary hyperparathyroidism is made through a simple combination of blood tests:
- Serum calcium: elevated above the normal range (typically >10.5 mg/dL)
- Intact parathyroid hormone (PTH): elevated or inappropriately normal in the setting of high calcium
- 24-hour urine calcium: helps rule out a benign hereditary condition called familial hypocalciuric hypercalcemia (FHH)
Once primary hyperparathyroidism is confirmed, imaging studies, including a sestamibi parathyroid scan and/or neck ultrasound, are used to locate the overactive gland before surgery.
Surgery Is the Only Cure
There is no medication that cures primary hyperparathyroidism. Cinacalcet (Sensipar) can temporarily lower calcium levels but does not remove the tumor or resolve the underlying disease.
Parathyroidectomy (surgical removal of the overactive parathyroid gland) is the only definitive treatment and has a cure rate exceeding 95% in experienced hands. Dr. Neychev performs minimally invasive parathyroid surgery, which involves a small incision, typically less than an inch, and most patients go home the same day.
Who Should Have Surgery?
Current guidelines from the American Association of Endocrine Surgeons recommend surgery for patients with primary hyperparathyroidism who meet any of the following criteria:
- Serum calcium more than 1 mg/dL above the upper limit of normal
- Evidence of kidney stones or nephrocalcinosis
- Osteoporosis (T-score below −2.5 at any site) or fragility fracture
- Age under 50
- Decreased kidney function (GFR < 60)
Even patients who do not meet formal surgical criteria often choose surgery because of the significant symptomatic improvement and the low risk of minimally invasive parathyroid surgery compared to a lifetime of monitoring.
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Frequently Asked Questions
Yes. Other causes include vitamin D toxicity, certain cancers (which produce PTH-related peptide), granulomatous diseases like sarcoidosis, and medications like lithium or thiazide diuretics. A specialist evaluation will determine the cause.
Not necessarily immediately, but the trend matters. Even mild hypercalcemia from hyperparathyroidism causes progressive bone loss and kidney damage over time. A surgical consultation with Dr. Neychev will help you weigh the risks and benefits.
Minimally invasive parathyroidectomy typically takes 45 to 90 minutes. Most patients go home the same day or the next morning.
For most patients, calcium normalizes within days of surgery. Some patients experience temporary low calcium (hypocalcemia) immediately after surgery, which is managed with calcium and vitamin D supplements.
Minimally invasive parathyroidectomy leaves a very small incision, usually less than one inch in length, which heals to a faint scar. The incision is strategically placed in a natural neck crease.
If your bloodwork shows elevated calcium, don’t wait. Schedule a consultation with Dr. Neychev at UCF Health to get a clear diagnosis and a path forward. Call (407) 266-3627 or click here to book.
References
- StatPearls (NCBI/NIH): Primary Hyperparathyroidism
- Cleveland Clinic: Parathyroid Surgery
- Endocrine Society: Primary Hyperparathyroidism Patient Guide
- Mayo Clinic: Hyperparathyroidism Symptoms & Causes
- NIDDK: Primary Hyperparathyroidism Overview
- Journal of Bone and Mineral Research: Evaluation and Management of Primary Hyperparathyroidism
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