DEAR DOCTOR. ROACH: I am an 88 year old male in fairly good health. I spend at least 30 hours a week gardening. I have had high levels of calcium in my blood for many years, usually around 10.7. I take Pravastatin and Triamteren / HCTZ. My doctor was a little concerned and was monitoring it. She sent me to an endocrinologist who did the same. Neither of them suggested treating it in any way.
I saw a veteran doctor recently who is more concerned. My last calcium level is 11 and she took me off the Triamteren / HCTZ. She also made me do a 24 hour calcium with a result of 266 mg / 24 hours.
I read on the internet that high blood calcium is more dangerous than high cholesterol. I am not in favor of surgery unless absolutely necessary, all the more so now in these times of coronavirus. At the moment she’s taking me to a specialist.
– W.
Dear Reader: It is very likely that you have a condition called primary hyperparathyroidism. This is caused by an excess of parathyroid hormone. I suspect one of your doctors has already confirmed this with a blood test. The parathyroid glands (usually four) are, as the name suggests, just next to the thyroid glands in the neck, but the parathyroid hormone is very different from the thyroid hormone. Besides vitamin D, parathyroid hormone is an important regulator of calcium levels in the blood. When a gland starts producing excess hormone, usually due to a benign tumor, the levels of calcium in the blood rise. Your VA doctor has appropriately stopped the Triamteren / HCTZ – it can increase the calcium in the blood – and also performed the 24-hour calcium test to make sure you don’t have an unusual condition called familial hypocalciuric hypercalcemia. The 24-hour calcium is also useful in deciding whether to recommend surgery, which is the only definitive treatment.
There are different indications for an operation. One is a very high blood calcium that is greater than a single point above normal (in most laboratories, 10.3 is the high end of normal, so one point above would be a blood calcium of 11.3). It is true that very high calcium levels increase the risk of heart problems, but the extent of the damage is relatively small and the benefits of surgery are not seen until 15 years after surgery.
One way PTH keeps blood calcium high is by pulling calcium out of your bones. Hence, you should make an assessment of your bone density. Most people don’t think men are at risk for osteoporosis, but at your age and with high PTH you are at risk. Osteoporosis is another indication for surgery, but it can also be treated with medication.
Another reason for surgery would be a history of kidney stones or deterioration in kidney function. Finally, some people have vague symptoms, including weakness, mild depression, or memory impairment, that may improve after surgery.
Given your desire to avoid surgery, I suspect that your VA doctor and consulting specialist will likely evaluate you a little more thoroughly and only recommend surgery if they believe surgery is clearly superior to medical treatment. I guess you don’t need an operation.
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