Tertiary hyperparathyroidism is a rare endocrine disorder where one or more parathyroid glands become enlarged and autonomously produce excessive parathyroid hormone (PTH). It develops after prolonged secondary hyperparathyroidism, typically in patients with chronic kidney disease. The Parathyroid Hormone (PTH), Intact test is the most important test for diagnosis as it directly measures elevated PTH levels alongside high blood calcium.
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Tertiary hyperparathyroidism is caused by prolonged secondary hyperparathyroidism, most commonly in patients with chronic kidney disease who have been on long-term dialysis. Over time, the parathyroid glands become overstimulated by chronic low calcium or high phosphorus levels, eventually becoming enlarged and autonomous. These glands then continue producing excessive parathyroid hormone (PTH) even after the original trigger is corrected, such as after a kidney transplant, leading to persistently elevated calcium and PTH levels in the blood.
The Parathyroid Hormone (PTH), Intact test is the most important test for tertiary hyperparathyroidism because it directly measures the level of intact PTH in your blood, which remains persistently elevated in this condition. This test is typically ordered alongside serum calcium, phosphorus, and vitamin D tests to distinguish tertiary hyperparathyroidism from primary and secondary forms. The hallmark finding is elevated PTH with high calcium levels that persist despite correction of the underlying kidney disease, confirming that the parathyroid glands have become autonomously overactive.
You should get tested if you have a history of chronic kidney disease or long-term dialysis and recently received a kidney transplant but continue experiencing symptoms like bone pain, fractures, fatigue, or kidney stones. Testing is also important if blood work shows persistently high calcium levels after your kidney function has improved, if you notice unexplained weakness or confusion, or if your healthcare provider detects signs of bone disease. Early detection through testing helps prevent serious complications like severe bone loss, cardiovascular problems, and organ damage from chronic high calcium levels.
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What this means
Your PTH level is slightly elevated above the optimal range. This may indicate your parathyroid glands are working harder than normal to regulate calcium levels, which could be due to vitamin D deficiency, early kidney issues, or mild parathyroid overactivity. While this elevation is modest, it's worth investigating the underlying cause to protect your bone health long-term.
Recommended actions
Get your vitamin D levels checked, as deficiency is a common cause of elevated PTH
Ensure adequate calcium intake through dairy, leafy greens, and fortified foods
Include magnesium-rich foods like nuts, seeds, and whole grains to support calcium metabolism
Retest PTH along with calcium and vitamin D levels in 3-6 months to monitor trends
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