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ParathyroidAtlanta, 1472 Montreal Road Suite 303, Tucker, GA (2026)

04/09/2026

Five Things to Know About Intraoperative PTH Monitoring

Patients often hear about intraoperative PTH monitoring and wonder whether it is required for parathyroid surgery.

Here are 5 practical points:

(1) It is a tool, not the whole operation.
Its role is to help confirm that the overactive parathyroid gland or glands have been removed.

(2) Some surgeons use it routinely. Others use it selectively.
That often depends on the case, the imaging, and the surgeon’s own approach.

(3) It can provide real-time feedback during surgery.
Because PTH levels usually fall quickly after removal of the abnormal gland, it can help confirm that the operation is working.
It has limitations.

(4) It can add time and cost, and the results still have to be interpreted in the context of the whole case.

(5) The most important question is not just whether it is used, but why.
A good surgical plan should make sense for the individual patient.

Different surgeons may use different methods, but the goal is the same: to treat hyperparathyroidism safely and effectively.

04/06/2026

How do you know if high calcium is coming from a parathyroid problem?

The most important test is the parathyroid hormone level (PTH).

Here is the key idea:

If your calcium is high, your parathyroid glands should normally respond by making very little PTH.

So:

High calcium + high PTH strongly suggests primary hyperparathyroidism
High calcium + “normal” PTH may also suggest hyperparathyroidism, because the PTH should actually be low
High calcium + low PTH usually means the parathyroid glands are responding normally, and the high calcium may be coming from some other cause

That is why doctors look at the calcium and PTH together, not just one number by itself.

Other tests may also help, including:

vitamin D
kidney function
urine calcium
bone density

One more important point: scans do not make the diagnosis. Imaging is often used later to help plan surgery, but the diagnosis of primary hyperparathyroidism comes from the lab findings.

If your calcium is repeatedly high, it is worth finding out why.

03/27/2026

A routine blood test shows high calcium. Now what?

Many people feel fine when this is first discovered. Others have symptoms like fatigue, brain fog, kidney stones, or bone loss and do not realize calcium may be part of the explanation.

A single mildly high calcium does not always mean there is a major problem. Dehydration, lab variation, medications, and other conditions can sometimes affect the result. But if the calcium is repeatedly high, it deserves attention.

In many cases, the next important step is to check the parathyroid hormone (PTH) level at the same time.

Here is the key point:
If calcium is high, the parathyroid glands should normally turn PTH down.
If the PTH is still high, or even “normal” when it should be low, that strongly points to primary hyperparathyroidism.

Age matters too. In younger adults, calcium levels can sometimes run a little higher. But in many middle-aged and older adults, a calcium level that stays above about 10 mg/dL should not be ignored.

If repeat testing confirms hyperparathyroidism, the evaluation may also include:
• vitamin D
• kidney function
• urine calcium
• bone density

The goal is not just to explain the number. It is to understand whether high calcium may already be affecting your bones, kidneys, energy, or quality of life.

If your calcium is repeatedly high, do not just file that result away. It is worth finding out why.

03/18/2026

Is there a “magic number” for high calcium?

One of the most common misunderstandings about high calcium is the idea that a slightly elevated calcium level must mean only a mild problem.

That is not always true.

When primary hyperparathyroidism is present, the calcium number by itself does not tell the whole story. What matters is whether the calcium level and the parathyroid hormone level fit the pattern of hyperparathyroidism.

Some patients are told to simply “watch it” when calcium is only modestly elevated. In some cases, follow-up may be appropriate. But a mildly elevated calcium level should not automatically be dismissed as unimportant.

Why?

Because the decision-making depends on more than one number. It may also depend on:

parathyroid hormone level

the pattern over time

bone health

kidney stone history

symptoms

age

other individual factors

Some patients have obvious symptoms. Others do not realize anything is wrong until they are evaluated more carefully.

The bottom line:
A calcium level does not have to be very high to deserve proper attention.

This post is for general education only and is not personal medical advice.

02/02/2026

What’s All the Hype About Vitamin K2?

Vitamin K2 has been getting more attention lately in relation to hyperparathyroidism, calcium, and vitamin D supplements, especially in conversations about bone health and calcium metabolism. Interestingly, despite a growing amount of information available online, vitamin K2 still lives mostly in the background when it comes to mainstream, peer-reviewed medical literature.

There are a few reasons for that. One is practical: vitamin K2 is not patentable in any meaningful way, which means there is very little financial incentive for large pharmaceutical companies to fund expensive clinical trials. As a result, you won’t see vitamin K2 featured prominently in the major journals the way you might see a new drug or device.

Another issue is that we don’t have a clearly established recommended daily allowance (RDA) for vitamin K2. Different populations consume very different amounts through diet, and the research hasn’t yet settled on a single “correct” dose. Complicating matters further, there is no widely available, reliable blood test to measure vitamin K2 levels. That makes large-scale studies harder to design and interpret.

It’s also important to clarify a common point of confusion: vitamin K2 is not the same as vitamin K1. Vitamin K1 is primarily involved in blood clotting and is what most people think of when they hear “vitamin K.” Vitamin K2, on the other hand, plays a different role—helping direct calcium to where it belongs, particularly into bones and away from soft tissues. Because they share a name, the two are often lumped together, but functionally they are quite distinct.

In my own practice, I have been recommending the addition of vitamin K2 alongside calcium and vitamin D for many years, particularly in patients concerned about bone health and calcium balance. Only more recently have other parathyroid experts begun to publicly emphasize the same approach.

Based on the available evidence and clinical experience, my personal recommendation for vitamin K2 (MK-7) supplementation is 200–300 micrograms daily. While this is not an official guideline, it reflects what I believe to be a reasonable and safe range for most adults.

As with many nutritional supplements, vitamin K2 sits at the intersection of emerging science and clinical judgment. The absence of large trials does not mean it lacks value—it often means the system has little incentive to study it.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your specific situation before starting any new supplement.

01/20/2026

What if my scans are normal, but my lab work is abnormal?

It is quite common for an endocrinologist to confirm a diagnosis of primary hyperparathyroidism with lab work and then order one or more scans to look for an abnormal gland. It is important to understand that it is not necessary to see an abnormal gland on imaging before an operation to know that you have primary hyperparathyroidism. But it seems that endocrinologists tend to want to “hedge their bets” before referring a patient for surgery. In addition, there are many surgeons who don't feel comfortable considering surgery without having a scan that shows a single abnormal gland.

The most experienced parathyroid surgeons feel quite comfortable proceeding with surgery even if scans are normal. They know that if the lab work confirms the diagnosis, then they will be able to identify the abnormal gland or glands at surgery, regardless of the scan findings. The scans are quite helpful as a roadmap in preparation for surgery. But the imaging should not be the determining factor.

Why do scans sometimes look normal? Parathyroid glands are tiny and sit close to the thyroid. Normal glands are almost never seen, and a small overactive gland may blend in, or it may sit behind the thyroid or lower in the neck where it’s hard to see. Ultrasound is also operator-dependent: subtle findings can be missed by people who do not perform or read these tests often. An expert review can sometimes spot clues that others overlook. Although an abnormal parathyroid gland might not be seen on a sestamibi scan if it sits behind the thyroid (its usual location), it is hard to miss if it sits somewhere else. It is important for the surgeon to know if an abnormal gland is in an ectopic location, because those are the ones that might not be found even by an experienced surgeon. As long as the sestamibi scan doesn't show an abnormal location for the parathyroid gland, the surgeon can confidently go ahead with surgery, even if the scan is read as normal.

Bottom line: Don’t delay treatment you need while waiting for a scan to “light up.” If your labs confirm primary hyperparathyroidism, talk with a surgeon who treats this every week and can walk you through cure rates, risks, and next steps for you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

01/19/2026

“My Endocrinologist says I have primary hyperparathyroidism, but he wants to watch it and not refer me for surgery. Why is that?”

The history of parathyroid surgery is pretty interesting. It started over a century ago, long before we had the advanced testing we use today. Back then, there was no way to measure parathyroid hormone (PTH) levels—only serum calcium could be tested. Patients often showed up with severe bone disease or kidney stones. Without a PTH test, doctors had to rule out every other possible cause of high calcium before suspecting a parathyroid problem. Endocrinologists became the go-to specialists for sorting through all those possibilities. Only when every other cause was eliminated would they conclude an overactive parathyroid gland was to blame, and that’s when a surgeon got involved.

Fast forward to today, and things are much simpler. We have a quick blood test to check intact PTH levels. If you have four normal parathyroid glands, they won’t overproduce PTH just because your calcium is high for another reason. Now, the first step when calcium is elevated is to check PTH. If it’s not suppressed, the diagnosis of primary hyperparathyroidism can be made right away. In fact, if you’re generally healthy and your calcium is consistently high, chances are good that’s the issue—so it’s smart to check this first.

Still, many primary care doctors send patients with high calcium to an endocrinologist, and some endocrinologists keep running through all the old possible causes even when it’s unnecessary if the PTH is already too high. They might diagnose primary hyperparathyroidism but downplay it, telling the patient, “It’s not that bad, let's just follow it”.

This likely comes from a time when parathyroid surgery wasn’t as safe or routine as it is today in skilled hands. They may not realize how symptomatic these patients can be, even when calcium and PTH levels aren’t “that high.” The truth is, parathyroid surgery is highly effective and very safe when performed by experienced surgeons. Most people with primary hyperparathyroidism have symptoms that can improve, often significantly, after a straightforward operation.

Maybe your endocrinologist ordered scans to locate an abnormal parathyroid gland, but they came back negative. So, what happens next? Stay tuned.

11/07/2025

“My calcium and PTH are high, but my vitamin D is low. Is vitamin D the problem?”

This is a very common mix-up. A true vitamin D deficiency does not cause high calcium. In fact, low vitamin D usually lowers or keeps calcium normal. When your parathyroid hormone (PTH) is high from primary hyperparathyroidism (PHPTH), it stimulates the kidney to convert vitamin D into its active form. The usual lab test measures 25-OH vitamin D (the “regular” vitamin D). Because your body is converting it into the active form, the 25-OH level can look low—like fuel being used up. That low number often reflects consumption, not a primary vitamin D problem.

Why does PTH do this? High PTH tells your intestines to absorb more calcium (through active vitamin D), your kidneys to save more calcium, and your bones to release calcium. In a healthy person, PTH rises when calcium is low to push it up. But in PHPTH, PTH is inappropriately high, so calcium stays too high.

If you have PHPTH plus low vitamin D, taking extra vitamin D can sometimes make you feel worse, because it adds “fuel” that helps the gut pull in even more calcium—pushing your blood calcium higher. That’s why the first step is not automatically taking big doses of vitamin D.

What to do instead: See an experienced parathyroid surgeon to confirm the diagnosis and discuss treatment options. After successful surgery (removal of the abnormal gland), it’s often appropriate to supplement vitamin D to rebuild bone and restore healthy levels—under your clinician’s guidance.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

11/03/2025

What Are the Symptoms of Abnormal Parathyroid Hormone Levels?

Parathyroid hormone (PTH) helps your body keep calcium in a healthy range. When PTH is too high—most often from primary hyperparathyroidism (PHPTH)—your calcium level can rise. High calcium and high PTH can affect many parts of your body, so symptoms can seem unrelated at first. You might notice one or two symptoms—or many. Not everyone has all of them.

Common symptoms with elevated PTH (often from PHPTH):
• Fatigue and low energy
• Brain fog or trouble with memory and focus
• Bone loss (osteoporosis) or fractures
• Kidney stones or frequent urination
• Bone and joint pain or aches
• High blood pressure
• Anxiety or depression or mood changes
• Gastrointestinal issues like nausea, constipation, or abdominal discomfort

Why do these happen? High PTH tells your bones to release calcium, your kidneys to keep more calcium, and your intestines to absorb more calcium. Over time, this can raise blood calcium and stress bones and kidneys, which leads to symptoms like fractures or stones. Mood and thinking can also be affected.

If you have symptoms—or repeated high calcium on blood tests—talk with your clinician. Diagnosis is based on labs (calcium and PTH together), sometimes repeated more than once. If you’re taking biotin (found in many hair/nail vitamins), stop it for about a week before PTH testing because it can skew results. The decision for or against treatment is best made with an experienced parathyroid surgeon, who can review your case and discuss options. For primary hyperparathyroidism, surgery is the only cure.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

10/29/2025

“My calcium is always high, but my PTH is ‘normal.’ Can it still be hyperparathyroidism?”

Yes—it can. When your blood calcium is high, healthy parathyroid glands should shut down and make very low PTH. If your PTH is still in the “normal” range while calcium is high, that PTH is inappropriately normal—it isn’t responding the way it should. This pattern can still mean primary hyperparathyroidism (PHPTH).
To make the diagnosis, your clinician should look at calcium and PTH together, not each number alone. A high calcium paired with a PTH that is not suppressed (high normal or high) supports PHPTH. Sometimes one set of labs is not enough. If the results are borderline or confusing, it’s common to repeat testing—often more than once.

For the most useful information, it helps to draw calcium and PTH at the same time, ideally in the morning. This keeps conditions consistent and makes the results easier to compare. Also, be aware that biotin supplements (often found in hair/nail vitamins) can interfere with some PTH tests and make the result look lower than it truly is. If you take biotin, it’s best to stop for about a week before testing (ask your clinician first).

Finally, decisions about testing and treatment are best made with an experienced parathyroid surgeon. They can review your history, symptoms, medications, and lab trends to confirm the diagnosis and discuss whether surgery is right for you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

10/13/2025

“My scans were normal—do I have to wait to see which gland is abnormal?”

Short answer: No. You can still be a good candidate for surgery even if your sestamibi scan and ultrasound look normal. Primary hyperparathyroidism (PHPTH) is diagnosed by your blood tests—a high calcium with an inappropriately high parathyroid hormone (PTH). Ultrasound and sestamibi can help plan surgery, but they are not required to make the diagnosis.

Why do scans sometimes look normal? Parathyroid glands are tiny and sit close to the thyroid. Normal glands are almost never seen, and a small overactive gland may blend in, or it may sit behind the thyroid or lower in the neck where it’s hard to see. Ultrasound is also operator-dependent: subtle findings can be missed by people who do not perform or read these tests often. An expert review can sometimes spot clues that others overlook.

Most important: the decision for or against surgery should be made with an experienced parathyroid surgeon. High-volume surgeons know how to plan an operation even when imaging is negative. Their goal is to cure the disease safely, with the lowest risk. They will match your labs, your symptoms, and any imaging to choose the best approach. If a scan later helps localize a gland, great—it can refine the plan. But a “perfect” scan is not a must-have before surgery.

Bottom line: Don’t delay treatment you need while waiting for a scan to “light up.” If your labs confirm PHPTH, talk with a surgeon who treats this every week and can walk you through cure rates, risks, and next steps for you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

10/08/2025

“They saw a thyroid nodule on my ultrasound—should I be worried?”

If you’re being checked for primary hyperparathyroidism (PHPTH), you might have an ultrasound of your neck. Good news: an ultrasound is not needed to diagnose PHPTH. Diagnosis comes from your blood tests—a high calcium with an inappropriately high parathyroid hormone (PTH). That said, ultrasound can help your surgeon plan the safest and smallest operation.

It’s common for the ultrasound to show a thyroid nodule. Thyroid nodules are very common in adults and most are benign. Many do not need more testing. If a nodule looks suspicious or is large, your doctor may suggest a fine-needle aspiration (FNA) biopsy. This is a quick office procedure that helps decide next steps.

When we do surgery for PHPTH, we rarely remove incidental thyroid nodules at the same time. Why? Because the main job is to fix the parathyroid problem first, with the least risk. If a thyroid nodule truly needs attention, it can be handled either during the parathyroid surgery or separately, after careful review.

Also, sometimes a “nodule” that seems to be in the thyroid is actually an enlarged parathyroid gland sitting right next to it. Your surgeon will compare the imaging with your labs and, if needed, other scans to tell the difference.

Bottom line: focus on getting the right operation for PHPTH the first time. Choose an experienced parathyroid surgeon—someone who does this often, can explain their cure rates, and has a clear plan if a nodule shows up on imaging.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

ParathyroidAtlanta

04/09/2026

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