Is a parathyroid hormone (PTH) level of 108 considered high?

From the Guidelines

Yes, a parathyroid hormone (PTH) level of 108 is considered high. The normal range for PTH is typically between 15-65 pg/mL (or 1.6-6.9 pmol/L), though reference ranges may vary slightly between laboratories 1. This elevated level suggests hyperparathyroidism, a condition where one or more of the parathyroid glands produce excessive amounts of PTH. Key points to consider in the management of elevated PTH levels include:

• Checking blood calcium levels, as hypercalcemia often accompanies primary hyperparathyroidism
• Considering other tests such as vitamin D levels, phosphorus, and kidney function tests
• Being aware of common symptoms of hyperparathyroidism, including bone pain, kidney stones, abdominal pain, fatigue, and depression, though many patients are asymptomatic
• Understanding that treatment depends on the cause but may include parathyroid surgery for primary hyperparathyroidism or addressing underlying conditions like vitamin D deficiency or kidney disease for secondary hyperparathyroidism 1. It's also important to note that the optimal PTH level in patients with chronic kidney disease (CKD) not on dialysis remains undefined, and high and progressively increasing PTH levels warrant investigation 1. In the context of CKD, increased PTH and incident secondary hyperparathyroidism are independently associated with CKD progression and cardiovascular events, mortality, and fractures 1. Therefore, managing elevated PTH levels is crucial to prevent these complications and improve patient outcomes.

From the Research

Parathyroid Hormone Levels

• A parathyroid hormone (PTH) level of 108 is considered elevated, as normal PTH levels are typically below 87 ng/liter 2.
• Elevated PTH levels can be caused by primary hyperparathyroidism (PHPT), secondary hyperparathyroidism (SHPT), or tertiary hyperparathyroidism (THPT) 3, 4.
• In some cases, elevated PTH levels can be resistant to conventional therapy, and treatment with cinacalcet may be necessary 5.

Normal and Elevated PTH Ranges

• Normal PTH levels are typically considered to be below 87 ng/liter 2.
• Elevated PTH levels can range from mildly elevated to severely elevated, with levels above 300 pg/ml considered to be significantly elevated 5.
• In the case of tertiary hyperparathyroidism, PTH levels can be extremely elevated, with ranges of 235-864 ng/liter reported in some studies 2.

Diagnosis and Treatment

• Diagnosis of elevated PTH levels typically involves a combination of laboratory tests, imaging studies, and clinical evaluation 4, 6.
• Treatment of elevated PTH levels depends on the underlying cause, with options including parathyroidectomy, cinacalcet, and vitamin D therapy 2, 3, 5.