PTH intact

[marlinfshr]

Can anybody decipher the meaning of a PTH intact test in my bloodwork?

Why I ask is that mine has risen quite sharply these past couple tests when it is usually well within normal. (usually 300 - 500 when 150 - 600 is normal) This past test was 839.

This time last year I had 1 test where my PTH went just above 600 so the DR ordered me to start taking Calsitrol (1 tablet every other day). I was a little upset with that and questioned why I all of a sudden need another pill when my bloodwork, which had been perfectly normal every other month was one time just a couple points above the normal high. Perhaps it was a problem with the test? My nurse agreed with me and told me to try without it as it could be a one time thing. the next month it returned well into the middle of the normal range (without the Calsitrol) and stayed there. Of course my DR stated how the Calsitrol helped, which I never took.

Now a year later I had the same issue (this time it was 619) so the fill in DR  and the new nurse gave me a hard time for not taking it, though all involved numbers have been perfect without it, except for my vitamin D which for the first time dropped a small amount. So, since I had another blood test comming up the following week I figured, what the H? So I took one every night leading up to the test. Now I just got the results back and my PTH is up to 839 so it is rising considerably above normal. Now reading the notation on the Davita site describing it it mentions I need to lower my phospherous? But my phoslerous was 4.3 and is always from 3.9 to 4.8. My calcium was 9 and is always right about there.

Now, leading up to my bloodwork I was having some indigestion a few nights so took tums. Could that raise PTH? I also drink lots of cokes but my phosherous is always perfect. As a matter of fact a year ago when my PTH first rose a tad, I gave a week leading up to the test a try to not drink any cokes so I drank lots of water. Then for the first time I had an issue with my bloodwork. Go figure!

Any way to decipher this so I have an idea what to bring up next time I see my Dr. It seems whenever something minor comes up all they do is perscribe another pill as if pills are the cure all. I don't buy into that.

Thanks

[Athena]

Marlinsfshr,

I don't know what stage of kidney functioning you may have, but I also struggle with the whole PTH-phosphorous-calcium equation. My phos & calcium levels are normal & always have been, but my PTH has been mildly elevated for the last 2 years. I don't like the thought that my bones are being weakened so I raised this mild elevation with my Neph & on my insistence, was prescribed calcitriol. I am very happy to take it & though it is a pill, I see it more as a 'supplement' in some strange way (like taking Vit D3, which most people do these days anyway). It has lowered my PTH to almost normal. I am just thrilled to see that!

It sounds to me that if you reduced your Coke intake, you might just have normal PTH levels without any additional pill. I would work on that doing that. If it is too hard to reduce your coke intake, then I would continue taking the calcitriol to keep it all in check. Either way, something needs to change to stay always in balance.

[iolaire]

PTH is the one lab value that keeps creeping up since I've been on dialysis and they aggressively give me IV meds during dialysis to get it under control.  Unlike other lab values they say PTH is not driven by what I eat so its something that they just need to keep under control via meds.

Here is the relevant paragraph from the DaVita site:  http://www.davita.com/kidney-disease/diet-and-nutrition/diet-basics/vitamin-d-and-chronic-kidney-disease/e/5326
The vitamin D, calcium, phosphorus and parathyroid hormone (PTH) connection

Healthy kidneys are rich with vitamin D receptors and play a major role in turning vitamin D into its active form. This helps balance calcium and phosphorus in your body by controlling absorption of these minerals from the food you eat and regulates parathyroid hormone (PTH).

When kidneys fail, their ability to activate vitamin D is lost. Without the activated vitamin D to control calcium and phosphorus levels in the blood, PTH will try to overcompensate and go out of range.

PTH is secreted by the parathyroid glands that are located in the neck near the thyroid glands. In kidney failure, the parathyroid glands may incorrectly sense that there is not enough calcium in the blood and produce excess parathyroid hormone which tells the body to pull calcium out of the bones and put it in the bloodstream. This excess of PTH can cause secondary hyperparathyroidism which can result in bone pain and weak bones that fracture easily. All patients with kidney failure are at risk for secondary hyperparathyroidism. For this reason, PTH levels are routinely monitored through lab work approximately every three months or more often if needed.

There are significant problems that may result with excess calcium in the blood stream. Calcium can deposit in soft tissues leaving “little rocks” in the tissue. These deposits or calcifications will never go away. The consequences of calcification are serious. If the heart becomes calcified, blood flow may be reduced, which could cause a heart attack. Calcification in the lungs can result in difficulty breathing. And, calcification in joints can cause extreme pain.

[Athena]

PTH is the one lab value that keeps creeping up since I've been on dialysis and they aggressively give me IV meds during dialysis to get it under control.  Unlike other lab values they say PTH is not driven by what I eat so its something that they just need to keep under control via meds.

Iolaire, according to my nephrologist, raised PTH levels is due to the kidneys inability to excrete phosphorous. All our foods contain phosphorous, some foods much more than others. When we consume too much phosphorous (or more accurately, our kidneys lose its ability to excrete it), then that triggers our parathyroid gland to release more hormone. However when this was explained to me, my Neph also added that phosphorous is found in every food!