From the Guidelines
Abnormal parathyroid hormone (PTH) levels can cause distinct symptom patterns, with high PTH levels typically causing fatigue, weakness, bone pain, kidney stones, excessive urination, abdominal discomfort, depression, memory problems, and bone fractures, while low PTH levels often present with muscle cramps, tingling in fingers and toes, facial spasms, seizures, and abnormal heart rhythms. These symptoms occur because PTH is crucial for maintaining proper calcium balance in the body, regulating calcium absorption from the intestines, reabsorption in the kidneys, and release from bone storage 1. The most recent and highest quality study, published in 2021, highlights the importance of PTH in maintaining calcium homeostasis and its impact on various bodily functions 1.
Some of the key symptoms of abnormal PTH levels include:
- Fatigue and weakness
- Bone pain and kidney stones
- Excessive urination and abdominal discomfort
- Depression and memory problems
- Bone fractures and osteoporosis
- Muscle cramps and tingling in fingers and toes
- Facial spasms and seizures
- Abnormal heart rhythms
Blood tests measuring both PTH and calcium levels are essential for proper diagnosis, as the relationship between these values helps determine if the parathyroid glands themselves are functioning abnormally or if they're responding appropriately to another underlying condition affecting calcium levels 1. The 2019 study published in Endocrine Reviews emphasizes the importance of PTH measurement in diagnosing and managing hyperparathyroidism and highlights the differences between PTH assays of different generations 1.
In terms of treatment, the 2018 study published in Annals of Internal Medicine suggests that treatment of secondary hyperparathyroidism should be based on trends in PTH level, rather than a single elevated value, and that calcitriol and vitamin D analogues should not be routinely used in patients with CKD G3a to G5 not on dialysis 1. The most effective treatment approach will depend on the individual patient's condition and should be guided by the most recent and highest quality evidence.
From the FDA Drug Label
Hypocalcemia: Life threatening events and fatal outcomes were reported. Hypocalcemia can prolong QT interval, lower the threshold for seizures, and cause hypotension, worsening heart failure, and/or arrhythmia. The most common adverse reactions (i.e., ≥ 25%) associated with cinacalcet were nausea and vomiting.
The symptoms of abnormal Parathyroid Hormone (PTH) levels include:
- Hypocalcemia: which can cause
- Prolonged QT interval
- Lowered threshold for seizures
- Hypotension
- Worsening heart failure
- Arrhythmia
- Nausea
- Vomiting 2 2 2
From the Research
Symptoms of Abnormal Parathyroid Hormone (PTH) Levels
The symptoms of abnormal PTH levels can vary depending on the specific condition.
- Hypoparathyroidism is characterized by hypocalcemia and low or undetectable levels of parathyroid hormone, leading to symptoms such as:
- Hypocalcemia
- Hyperphosphatemia
- Low levels of 1,25-dihydroxyvitamin D
- Calcifications in the kidney, brain, and other soft tissues 3
- Primary hyperparathyroidism (PHPT) can present with non-specific signs and symptoms of hypercalcemia, including:
- Secondary hyperparathyroidism, often caused by chronic kidney disease-mineral and bone disorder (CKD-MBD), can lead to symptoms such as:
- Hypocalcemia
- Hyperphosphatemia
- Elevated PTH levels 6
- Tertiary hyperparathyroidism can also occur, often as a result of prolonged secondary hyperparathyroidism, and can lead to similar symptoms as primary hyperparathyroidism 6
Treatment and Management
Treatment for abnormal PTH levels depends on the underlying condition and may involve:
- Calcium and vitamin D replacement for hypoparathyroidism 3, 7
- Parathyroidectomy for primary hyperparathyroidism 4, 5
- Medical management with phosphate binders, vitamin D analogs, and calcimimetics for secondary hyperparathyroidism 6
- Optimization of calcium and vitamin D intake, as well as antiresorptive therapy, for patients with primary hyperparathyroidism who are not undergoing parathyroidectomy 4