Endocrine Surgery

High PTH Levels After Parathyroid Surgery

High PTH After Parathyroid Surgery | UCLA Endocrine Center

Michael Yeh here from UCLA Health Endocrine Surgery, here to discuss high PTH levels after surgery for primary hyperparathyroidism. 

If you’ve had surgery for primary hyperparathyroidism, it's natural to have questions about your PTH (parathyroid hormone) levels afterward—especially if they're still high. Here's what you need to know:

When Is Surgery Considered Successful?

  1. Primary hyperparathyroidism is usually caused by a single overactive parathyroid gland (adenoma).
  2. During surgery, surgeons monitor PTH levels in real-time to ensure they drop, confirming that the abnormal tissue has been removed.
  3. After surgery:
    1. PTH levels drop immediately
    2. Calcium levels normalize over hours to days

What If PTH Is found to be high after surgery?

PTH and Calcium Are Both High:

  1. This could mean there's another overactive gland that wasn’t removed.
  2. It’s rare, but this may require a second operation.

PTH Is High but Calcium Is Normal (Most Common):

  1. This is called "eucalcemic PTH elevation" and happens in 25–40% of patients after successful surgery.
  2. Good news: This does not usually need treatment or another surgery.

Why Is the PTH level Still High Even If the blood Calcium level Is Normal?

Several possible reasons:

  1. Low vitamin D – Common and reversible
  2. Kidney disease – Can cause high PTH without high calcium
  3. No clear reason – Some people just seem to have a higher “set point” for PTH to achieve a normal blood calcium level

Even if the cause isn’t found, this condition isn’t dangerous and doesn’t harm your health.

Does It Mean Hyperparathyroidism Will Come Back?

  1. A persistently high PTH could slightly raise the risk of recurrent hyperparathyroidism down the line.
  2. But this only becomes a concern if calcium also rises again.

Bottom Line

  1. A high PTH level alone after parathyroid surgery is usually not a problem.
  2. As long as your calcium levels are normal, there’s no cause for concern.
  3. Follow-up typically includes:
    1. Calcium and PTH labs
    2. Vitamin D check
    3. Kidney function tests

Once again this is Michael Yeh from UCLA Health Endocrine Surgery, and thank you for watching.

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