PTH

PTH is requested to help determine the cause of a low or high calcium concentration, to help distinguish between parathyroid-related and non-parathyroid-related causes. It may also be requested to monitor the effectiveness of treatment when a patient has a parathyroid-related condition. PTH should be requested with serum calcium as this allows an evaluation of the response of the parathyroid glands to changing concentrations of calcium. 

High blood calcium concentrations (hypercalcaemia ) may be due to a condition called hyperparathyroidism, where there is overproduction of PTH by the parathyroid gland. Hyperparathyroidism is separated into primary and secondary hyperparathyroidism. Primary hyperparathyroidism is most frequently due to a parathyroid tumour (usually benign, but very rarely cancerous) that secretes PTH without feedback control. This excessive PTH can cause hypercalcaemia, and can lead to kidney stones, calcium deposits in organs, and decalcification of bone. With primary hyperparathyroidism, patients will generally have both high calcium and high PTH levels. 

Secondary hyperparathyroidism is usually due to kidney failure. Kidney disease may impair the production of the active form of vitamin D, and this in turn leads to reduced calcium uptake from the diet. As phosphate levels build up and calcium levels fall, PTH is secreted. Secondary hyperparathyroidism can also be caused by any other condition that causes low calcium, such as malabsorption of calcium due to intestinal disease and vitamin D deficiency. In secondary hyperparathyroidism, patients will generally have high PTH concentrations and a low or normal calcium result. Sometimes, people with secondary hyperparathyroidism develop high serum calcium concentrations, and still have high PTH, a condition known as tertiary hyperparathyroidism. 

Low blood calcium concentrations (hypocalcaemia ) may be due to hypoparathyroidism, where there is a failure of the parathyroid gland to produce PTH. 

PTH can also be used to monitor patients who have conditions or diseases that cause chronic calcium imbalance, and to monitor those who have had surgery or other treatment for parathyroid tumours. 

PTH may be requested when a blood calcium or phosphate result is abnormal. PTH may be requested when you have hypercalcaemia, which may cause symptoms such as tiredness, sickness, stomach pain, and thirst. PTH may also be requested when you have hypocalcaemia, which may cause symptoms such as muscle cramps and tingling fingers. Your doctor may request a PTH, along with calcium (and other tests) as a way of monitoring changes when you have had treatment for diseases or conditions that affect calcium regulation, such as the removal of a parathyroid tumour, or when you have chronic conditions such as kidney disease. 

When a person has hyperparathyroidism, the usual treatment is surgery to remove the enlarged gland or glands. Usually in primary hyperparathyroidism, only one abnormal parathyroid gland is present, but in some cases two or more of the glands are abnormal. In secondary hyperparathyroidism, usually all four of the parathyroid glands are affected. During surgery, it is important for the surgeon to make sure that all of the abnormal glands have been removed. If all are abnormal, this usually means removing three glands completely and part of the fourth, leaving behind just enough parathyroid tissue to prevent hypoparathyroidism. One way to be sure that all of the abnormal tissue has been removed is to measure PTH before and after an apparently abnormal gland has been removed. If all the abnormal tissue is gone, PTH levels will fall by over 50% within 10 minutes. To be useful, this requires that the laboratory be able to provide the results quickly (this is often called rapid or intra-operative PTH measurement). This is not available in all UK laboratories. 

A PTH result needs to be evaluated relative to a serum calcium measured at the same time. If both PTH and calcium results are normal, and appropriate relative to each other, then it is likely that calcium regulation is normal. 

Low concentrations of PTH may be due to conditions causing hypercalcaemia, or to an abnormality in PTH production causing hypoparathyroidism. Excess PTH secretion may be due to hyperparathyroidism, which is most frequently caused by a benign parathyroid tumour or kidney disease.

Calcium - PTH Relationship

If calcium concentrations are low and PTH concentrations high, then PTH is responding as it should. Depending on the degree of hypocalcaemia, your doctor may investigate the low calcium further by looking at your vitamin D, phosphate, and magnesium levels. 

If calcium concentrations are low and PTH concentrations are normal or low, then PTH is not responding to the change in calcium appropriately, and you may have hypoparathyroidism or magnesium deficiency which blunts PTH secretion. 

If calcium concentrations are high and PTH concentrations are high, then your parathyroid gland is producing inappropriate amounts of PTH and your doctor may request X-rays or other imaging studies to check for the cause and severity of hyperparathyroidism. 

If calcium concentrations are high and PTH concentrations are low, then your calcium regulation system is working normally but your doctor will do some further investigations to check for non-parathyroid related reasons for your elevated calcium. 

If calcium concentrations are normal and PTH concentrations are high, then your parathyroid gland is having to produce more PTH than normal to maintain your blood calcium level. This is most commonly due to either vitamin D deficiency or chronic kidney disease.

‘Intact’ PTH is broken down into several molecular fragments including: an N-terminal, a C-terminal, and a mid-region fragment. While each of these fragments can give the doctor information about calcium regulation, intact PTH is measured most frequently as it is the major biologically active form. 

Drugs that may increase PTH concentrations include: phosphates, anticonvulsants, steroids, isoniazid, lithium, and rifampin. 

Drugs that may decrease PTH include cimetidine and propranolol. 

Yes, if your calcium level changes slowly you may not have any noticeable symptoms.