Hyperparathyroidism: An Often Overlooked Differential Diagnosis to ME/CFS

Legendrew submitted a new blog post:

Hyperparathyroidism: An Often Overlooked Differential Diagnosis to ME/CFS

Andrew Gladman puts hyperparathyroidism under the microscope, exploring what the disease is, how it can mimic ME/CFS in presentation and how it is treated.

Chronic fatigue syndrome or ME/CFS is, whether we like it or not, by current definition a diagnosis of exclusion. The biggest diagnostic task is therefore differentiating it from the plethora of other disorders that also have a fatigue component.

ME/CFS may be distinguished from other causes of fatigue on the basis of certain presenting symptoms such as cognitive dysfunction, which is not present in almost all other fatigue-producing disorders. Once a specific cause of fatigue has been diagnosed, CFS is then excluded, by definition.

The problem that arises, however, is that almost any chronic illness that produces extensive disability and fatigue may be included in the differential diagnosis. Therefore it is very difficult to ensure that everything is adequately ruled out before a diagnosis of ME/CFS is reached.

This diagnosis of exclusion is often a very time-consuming and expensive task. For these reasons the diagnosis of ME/CFS is often given somewhat prematurely.

Conditions that can cause fatigue include the following:

  • Chronic heart disease
  • Psychiatric illnesses
  • Thyroid diseases
  • Connective tissue diseases
  • Chronic anemia
  • Neoplastic (cancerous) disease
  • Chronic infections (e.g., HIV/AIDS)
  • Endocrine diseases (e.g., Addison disease)
  • Inflammatory bowel disease
  • Drug abuse
  • Liver disease
  • Renal disease
From this broad, but far from exhaustive, list it is clear that there is an abundance of very different conditions that need to be excluded before ME/CFS is diagnose. However one disease that is often omitted from such lists is hyperparathyroidism.

Often mistaken for its close namesake, hyperthyroidism, hyperparathyroidism in fact has nothing in common with the thyroid in function, and is so named because the troublesome gland in question simply lies in such close proximity to the thyroid.

There are two different types of hyperparathyroidism: primary and secondary.

Primary hyperparathyroidism is caused by one or more benign tumours (adenomas) of the parathyroid glands. Normally these glands control blood calcium levels by secreting parathyroid hormone (PTH) when blood calcium levels drop beyond the normal range.



Diagram showing location of parathyroid glands
PTH stimulates the release of calcium from the bones and also stimulates the conversion of inactive vitamin D to active vitamin D, which aids in the digestion of calcium. When an adenoma is present, very high levels of PTH are released which results in a high level of blood calcium. It is this hypercalcemia which is thought to produce the symptoms.
The symptoms of hyperparathyroidism include weakness and fatigue, depression, bone pain/osteoporosis, muscle soreness (myalgias), nausea/vomiting, constipation, headaches, frequent urination (polyuria) and kidney stones.

The symptoms typically develop slowly. However, they may appear very suddenly and severely. This is often known as a parathyroid crisis and can be fatal if left untreated.

Hyperparathyroidism is also associated with a high risk of pancreatitis (both acute and chronic) which can cause acute abdominal symptoms such as cramping, nausea and diarrhea.

Furthermore, hyperparathyroidism is very often seen in combination with a vitamin D deficiency which can make diagnosis somewhat more difficult. From the above list alone, it is clear to see why hyperparathyroidism should always be tested for in ME/CFS patients, given the similarity of the symptom presentation.

The tests for this condition are blood calcium which shows as unusually high, parathyroid hormone levels which are very high, alkaline phosphatase which can sometimes be elevated, vitamin D levels which are very often low and phosphate which is also sometimes low.

Testing can prove difficult however, with calcium and PTH levels fluctuating quite wildy. This however is quite indicative of the condition, as under normal circumstances calcium and PTH remain very consistent. If hyperparathyroidism is suspected, then a scan will be recommended to try and see whether there is a visible tumour present, although diagnosis is made through blood tests alone.

As previously mentioned, there is also a condition known as secondary hyperparathyroidism, in which PTH levels are elevated. However, this only usually occurs in patients with chronic renal failure, abnormally low levels of calcium (hypocalcemia) and sometimes as a result of vitamin D deficiency. This is normally differentiated from primary hyperparathyroidism by correcting the deficiency and observing the calcium and PTH level response.

The first line of treatment for primary hyperparathyroidism for the majority of patients is a minor surgery, under general anesthesia, to remove the tumour which in turn removes the PTH excess and allows the calcium levels to return to normal.

This is not a major surgery, with the majority being done today via keyhole surgery, and is usually undertaken as an outpatient procedure. This surgery also boasts impressive cure rates as high as 95% with the remaining 5% often having another parathyroid tumour which was missed during the first surgery.

Of all the missed diagnoses of ME/CFS and fibromyalgia, primary hyperparathyroidism proves to be one of the most tragic simply as a result of how treatable the condition is relative to the suffering it can cause.

If any of the symptoms sound somewhat familiar, be sure to mention this to your primary care physician. A couple of simple blood tests could lead you to a long overdue answer to your personal health problems!

For more information on hyperparathyroidism be sure to visit Parathyroid.com.


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Comments

Here's a couple of studies that show that vitamin D and calcium both lower PTH in Primary Hyperparathyroidism.
The effects of calcium supplementation to patients with primary hyperparathyroidism and a low calcium intake.
Prolonged treatment with vitamin D in postmenopausal women with primary hyperparathyroidism.

I think the more reasonable hypotheses is that PTH increases conversion of 25OHD to the active form, attempting to increase calcium absorption, thus reducing 25OHD levels and causing a deficiency. People typically have normal/high 1,25(OH)2 D even if they have low 25OHD.

Yes, I understand that the elevated serum calcium is a problem and a risk. Nonetheless it should be doable, especially under a doctor. But it's hard to find a doctor willing to try things like this ...

Additionally, there are ways to reduce that serum calcium.
I am being tested for hyperparathyroidism this week. My alkaline phosphatase is a bit raised, has been for years, blood calcium raised but still high normal but it fluctuates as well as very low vitamin D. I'm having a procedure on Wednesday to remove two kidney stones that have remained in my kidney since last March and have become problematic as far as flank pain causing me to flare.

Only time will tell whether I have this or not. I suspect not but I have a 50% of being right or wrong.:D

While there are conditions where you can only treat the symptoms, untreated hyperparathyroidism is dangerous and symptoms may not necessarily correlate with the calcium levels. if I understand correctly, lowering calcium and and PHT through the ways you suggested, doesn't cure the cause which is an adenoma in the parathyroid gland(s).

Parathyroid glands control the amount of calcium in our blood and bones. About 1 in 100 people (1 in 50 women over 50) develop a parathyroid gland tumor during their lifetime causing parathyroid disease, called: "hyperparathyroidism". Hyperparathyroidism is a destructive disease that causes high blood calcium--which leads to serious health problems--even early death. It can be cured in most patients in less than 20 minutes with parathyroid tumor removal. Hyperparathyroidism is not just an abnormal lab value that can be monitored by your doctors. Bad things will always occur and thus the parathyroid tumor should be removed in virtually all cases
.

Hyperparathyroidism is an interesting disease in that it can show up differently in different people. Sometimes it makes people miserable within the first year or two of having high blood calcium. Other times it can go 6-8 years without causing too many problems other than fatigue, bad memory, kidney stones, and osteoporosis. But make no mistake about it, hyperparathyroidism kills people--it just takes 20 years to do so (read blog on this topic). We have taken care of tens of thousands of people with primary hyperparathyroidism and we can't remember seeing a patient who had parathyroid disease for more than 25 years. We have only seen a handful who have lived 20 years with a parathyroid tumor. They have all died of heart failure, breast or prostate cancer, kidney failure, stroke or heart attack. Hyperparathyroidism is a simple benign disease that will slowly destroy your body and take away the "joy of life" while it does so. It will make you miserable! Keep reading to see how this hormone-producing tumor makes you feel bad. The good news is that hyperparathyroidism is typically very easy to cure
http://www.parathyroid.com

The above site was recommended by Aidan Walsh.. It seems to say the same thing I have read other sites, but somtimes Dr. Google can be misleading and I am not a medical professional.

Barb
 
There is now a neurologist in Brazil reversing illnesses his name is Dr. Coimbra he is calling M.S., auto immune conditions including cfs fibro a 'Partial Vitamin D deficiency' he uses high doses of Vitamin D3 anyone over 10,000 i.u. daily must stop all dairy foods calcium intoxication it also has to do with the Parathormone Parathyroid, also he says

get B2, B12, Omega 3 Fish Oils other wise D3 will not work without the Omega 3 also magnesium, 2.5 litres daily of water to wash out access calcium eat foods like fish chicken some meats get your calcium from vegs/fruits ones you can tolerate Kale a wise choice Brocoli...Avoid dairy over 10,000 i.u. D3 a must to be followed by your physician if you

are on thyroid meds you must be stabilized first, there have not been any toxicities seen in his research since he commenced arourd 2002 first he gave 10,000 i.u. to Parkinsons & Alzheimers with immediate improvements... I take now 50,000 i.u. daily no dairy whatsoever it will not work overnight it takes months/years to recover he says as much

as 50% of Brazil are D deficient...It has over 4500 mecanisms gene expressions, anti viral, anti bacterial, anti fungal like a key in 4500 doors the master key fits all doors...M.S. patients have now reversed lesions some after 2 years no longer have to see this neurologist all tests return to normal he says not 'cure' it's a lifetime cure treatment you

must be on for life he brings up the vitamin D levels high, he watches Calcium/Parathormone levels more than the D levels :) I will try post some of his youtube videos there is one girl with M.S. totally well she is on a maintenance dose now she forgets she had M.S. one of his former patients CFS is now under him as a fully trained Doctor when she

recovered she decided to become a Doctor & did her internship under Dr. Coimbra...Rule out Parathyroid tumors as well also if you start protocol do these bloods prior vitamin D, Parathormone plus Calcium blood if possible 24 hour Calcium urine collection, hormones if you want as well plus any Bone Scans would be a marker...Buy natural

vitamin D3 gel form or up to you D3 oil drops I prefer gel caps easier to take make sure take with meals...Multi vitamins natural are good if you can tolerate B complex vitamins/minerals that's fine eat healthy as much as possible I drink water only, hot water boiled while eating I eat no sugar I no longer eat any gluten free b.s. foods

eliminated I make my own breads from coconut flour/oils etc healthier... There are now 2 Facebook links one is in Italian other is in Portugese Brazil language the videos are in Portugese with English subtitles...On my Facebook page I have posted numerous numerous links to Brazil as well videos :) I will try post some links videos as soon as I can... blesses get well soon...end of this post: :)
 
blood test on Calcium is a blood test your Doctor would know to run plus you could ask for urine calcium as well it may be sample or 24 hour collection plus parathormone vitamin d3 levels...They would know what are to be done just make sure Dairy completely eliminated it is in lots of foods so avoid but 3 litres daily of water flushes our excess Calcium do not eat dairy your kydneys could fail/dyalisis then...Serious stuff 'no Calcium' even Tums or pill forms Oscal etc stay off them...Get calcium via vegs/fruits drink daily water
 
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I am being tested for hyperparathyroidism this week. My alkaline phosphatase is a bit raised, has been for years, blood calcium raised but still high normal but it fluctuates as well as very low vitamin D. I'm having a procedure on Wednesday to remove two kidney stones that have remained in my kidney since last March and have become problematic as far as flank pain causing me to flare.

Only time will tell whether I have this or not. I suspect not but I have a 50% of being right or wrong.:D

While there are conditions where you can only treat the symptoms, untreated hyperparathyroidism is dangerous and symptoms may not necessarily correlate with the calcium levels. if I understand correctly, lowering calcium and and PHT through the ways you suggested, doesn't cure the cause which is an adenoma in the parathyroid gland(s).

Other things coming up now Hashimoto's antibodies, SIBO including test to rule in/out Hypoptuitarism ACTH is a useless test it is another type of simialr test to be done through Hospital or Privately but this condition also could be linked to Radiation or other potential causes :)'s

.



http://www.parathyroid.com

The above site was recommended by Aidan Walsh.. It seems to say the same thing I have read other sites, but somtimes Dr. Google can be misleading and I am not a medical professional.

Barb
 
Dr. Google actually has taken patients away from CFS/Fibro diagnosis some now diagnosed with Hypopituitarism as a result of injuries, Sports traumas, auto accidents, whiplashes etc etc which is missed with the ACTH tests but there is another specific test that rules it in/out...Dr. Google 'saves lives' not everyone has CFS/Fibro on these forms afterall there is not one test that says yes you have this illness refered to as 'fatigue' I have an abnormality on my MRI on the pituatary gland they say lesion others say tumor of 4cm one Doctor said I could have be born with it as well but injuries could have been possible...Maybe :)'s Dr. Google will give me a proper diagnosis...LOL :)'s
 
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I am being tested for hyperparathyroidism this week. My alkaline phosphatase is a bit raised, has been for years, blood calcium raised but still high normal but it fluctuates as well as very low vitamin D. I'm having a procedure on Wednesday to remove two kidney stones that have remained in my kidney since last March and have become problematic as far as flank pain causing me to flare.

Only time will tell whether I have this or not. I suspect not but I have a 50% of being right or wrong.:D

While there are conditions where you can only treat the symptoms, untreated hyperparathyroidism is dangerous and symptoms may not necessarily correlate with the calcium levels. if I understand correctly, lowering calcium and and PHT through the ways you suggested, doesn't cure the cause which is an adenoma in the parathyroid gland(s).

.Let me know Barbc56 what your Hyperparathyroid turns out to be I checked my level on Alkaline Phosphatase it was in normal range at 49 (39-137) but low range normal



http://www.parathyroid.com

The above site was recommended by Aidan Walsh.. It seems to say the same thing I have read other sites, but somtimes Dr. Google can be misleading and I am not a medical professional.

Barb
 
Dr. Google actually has taken patients away from CFS/Fibro diagnosis some now diagnosed with Hypopituitarism as a result of injuries, Sports traumas, auto accidents, whiplashes etc etc which is missed with the ACTH tests but there is another specific test that rules it in/out...Dr. Google 'saves lives' not everyone has CFS/Fibro on these forms afterall there is not one test that says yes you have this illness refered to as 'fatigue' I have an abnormality on my MRI on the pituatary gland they say lesion others say tumor of 4cm one Doctor said I could have be born with it as well but injuries could have been possible...Maybe :)'s Dr. Google will give me a proper diagnosis...LOL :)'s
I know this is a really old post, but do you know what the other specific test is, other than ACTH, that rules out hypopituitarism?
Thanks!