Table of Contents
Introduction
Calcium is more than just a building block for bones—it’s essential for heart rhythms, nerve function, muscle contraction, and more. Yet many women with normal calcium intake still find themselves struggling with unexplained fatigue, bone pain, kidney stones, or osteoporosis.
We often overlook parathyroid hormone (PTH), which may be missing. Produced by four small glands in the neck, PTH is a master regulator of calcium levels in the body.
Women—especially those in midlife or with autoimmune or thyroid conditions—are disproportionately affected by parathyroid disorders.
Understanding how PTH works and your levels can help you take proactive steps toward better hormonal health, whether you have hyperparathyroidism, hypoparathyroidism, or abnormal blood test results.
This article discusses PTH, how to test it, and the latest treatment options for PTH-related conditions.
What Is Parathyroid Hormone?
Parathyroid hormone (PTH) is a protein secreted by the parathyroid glands, four tiny glands behind the thyroid. Its primary role is maintaining calcium and phosphate balance in the blood and bones.
PTH's Role in Calcium & Bone Metabolism
Calcium levels in the blood must remain within a very tight range for the body to function normally. PTH raises calcium levels when they fall too low. It does this in three main ways:
- Bones: PTH stimulates bone resorption by activating osteoclasts—cells that break down bone tissue, releasing calcium into the bloodstream.
- Kidneys: PTH reduces calcium loss in the urine and increases phosphate excretion.
- Vitamin D activation promotes the conversion of vitamin D into its active form (calcitriol), increasing calcium absorption from the intestines.
Calcium and PTH work like a balancing act—when calcium levels go down, PTH goes up to bring them back to normal, and when calcium is high, PTH drops. If you throw this balance off, it can lead to serious health issues.
How the Parathyroid Glands Work
The parathyroid glands monitor serum calcium continuously. They respond within seconds to changes in calcium levels by adjusting PTH secretion.
Unlike the thyroid gland, they don’t directly influence metabolism, weight, or energy, but they have an enormous impact on bone health, kidney function, and neuromuscular stability.
Disorders of these glands typically fall into two categories. Hyperparathyroidism is the overproduction of parathyroid hormones, while the underproduction of parathyroid hormones is called hypoparathyroidism.
PTH Blood Testing
Testing PTH levels is one of the most important steps in evaluating unexplained high or low calcium levels, muscle cramps, bone pain, or fatigue.
Normal vs. Abnormal PTH Levels
A PTH blood test measures the amount of parathyroid hormone in the blood. Normal PTH levels generally range between 10–65 pg/mL (picograms per milliliter), though reference ranges may slightly vary between labs.
- High PTH + High Calcium → Likely Primary Hyperparathyroidism
- High PTH + Low/Normal Calcium → Possibly Secondary Hyperparathyroidism
- Low PTH + Low Calcium → Hypoparathyroidism
These patterns are fundamental in distinguishing between hyperparathyroidism and hypoparathyroidism, as treatment plans are entirely different.
Interpreting PTH with Calcium and Vitamin D
Because PTH doesn’t operate in isolation, your physician must make sure the results are always interpreted alongside:
- Serum calcium (total and ionized)
- Phosphate
- Vitamin D (25-hydroxy and 1,25-dihydroxy forms)
- Magnesium (low levels can blunt PTH secretion)
- Creatinine (for kidney function)
Low vitamin D can falsely elevate PTH as the body compensates for reduced calcium absorption. Performing the PTH blood test with a full metabolic panel is critical before jumping to conclusions or pursuing treatment.
Parathyroid Disorders
PTH disorders are common but often underdiagnosed in women, particularly those in midlife. Here’s a closer look at the two major types.
Hyperparathyroidism
Primary hyperparathyroidism occurs when one or more parathyroid glands produce excess hormone, usually due to a benign adenoma (non-cancerous tumor). The overproduction leads to high blood calcium levels and symptoms that may include:
- Bone pain or osteoporosis
- Kidney stones
- Fatigue and weakness
- Constipation
- Mood disturbances
Women over 50 are especially vulnerable. Left untreated, it can lead to long-term complications like bone loss and cardiovascular issues.
Secondary hyperparathyroidism, by contrast, is typically a response to low calcium or vitamin D, often seen in chronic kidney disease or malabsorption syndromes. Here, PTH rises not because of gland overactivity but because the body is trying to correct low calcium levels.
Hypoparathyroidism
Hypoparathyroidism is much less common but can be more immediately dangerous. It involves low PTH levels, often after thyroid or neck surgery, or due to autoimmune destruction of the glands. Symptoms can include:
- Tingling in the fingers and around the mouth
- Muscle cramps or spasms (tetany)
- Seizures in severe cases
- Brittle nails and thinning hair
Over time, low PTH can lead to calcium deposits in the brain or kidneys, cataracts, and osteosclerosis (abnormally dense bones
Treatment Options
The treatment for parathyroid hormone imbalances depends on the underlying condition and the severity of symptoms.
Surgery for Hyperparathyroidism
Parathyroidectomy, the surgical removal of the overactive gland(s), is the most effective treatment for primary hyperparathyroidism. This process is often recommended when:
- Calcium levels are high.
- Bone density is declining.
- Kidney stones are present.
- Symptoms are interfering with quality of life.
Minimally invasive surgery is now standard, and parathyroid surgery recovery is typically smooth, with most patients returning to normal activities within a few days.
For women who aren’t surgical candidates, monitoring plus medications like bisphosphonates or cinacalcet may be considered.
Calcium and Vitamin D Therapy for Hypoparathyroidism
Treatment for hypoparathyroidism focuses on maintaining blood calcium within a safe range and often involves:
- Calcium supplements (typically calcium carbonate or citrate)
- Active vitamin D (calcitriol) to enhance calcium absorption
- Magnesium supplements (as needed)
- Thiazide diuretics to reduce urinary calcium loss
In some cases, recombinant PTH therapy (Natpara) may be prescribed, though it’s currently under review due to concerns about long-term safety and supply availability.
Women should work closely with their healthcare provider to fine-tune therapy, as both over- and under-treatment carry risks.
Frequently Asked Questions
Chronically high PTH levels—especially in primary hyperparathyroidism—can lead to:
- Osteoporosis and fractures
- Kidney stones
- Abdominal pain or nausea
- Fatigue, memory issues, and mood changes
It’s important not to ignore mildly elevated calcium, as damage can occur even in asymptomatic patients.
In cases of temporary hypoparathyroidism (e.g., after thyroid surgery), PTH levels may recover over time. However, lifelong management with supplements or synthetic PTH may be necessary if glands are permanently damaged or absent.
A PTH blood test is done via a standard blood draw, typically fasting. It’s often ordered alongside calcium and vitamin D to understand your parathyroid function comprehensively. Results usually return within 1–2 days.
Final Thoughts for You
If your physician tells you your calcium or PTH levels are off—or if you’re dealing with unexplained bone thinning, kidney stones, or fatigue—it’s time to take action.
Parathyroid hormone plays a central role in calcium regulation and bone health. Identifying the problem is the first step toward regaining balance, whether managing hyperparathyroidism or hypoparathyroidism.
A skilled endocrinologist can help interpret your labs, recommend appropriate testing, and guide treatment—surgery, supplements, or monitoring. Remember, early detection and targeted treatment can dramatically improve your quality of life when it comes to parathyroid hormone.
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