Elevated PTH/Vitamin D def.
R C
on 5/21/07 12:46 am - IA
on 5/21/07 12:46 am - IA
I have a question for all of you. Has anyone else been diagnosed with elevated parathyroid hormone, which is secondary to a vitamin D deficency? I was prescribed Vitamin D 50,000 IU to be taken every day. I am just a little scared to take this much since my pharmacist questioned the dosage and reading on the internet it is a toxic dose. Just wondering what other have experienced.
Thanks
Kourtney
Kourtney,
How low is your Vitamin D level? I've heard of doctors giving doses of 50,000 to get levels up quickly. Mine was in the 20s and our nutritionists now want it 40 or above but my doc didn't want to use the big dose on me so we just upped by 400 ius per day and then upped it one more time and my labs improved. I'm now at 1200 ius a day on top of what is in my calcium supplements and multis and my labs are in the mid-40s to 50.
How much calcium are you taking? What form? Citrate in doses of no more than 500 mg at a time, I hope. Elevated PTH can mean that you aren't getting enough calcium too.
I had PTH issues prior to WLS due to a parathyroid adenoma (tumor) so that is considered primary hyperparathyroidism. So I had high calcium levels and high PTH due to the overstimulation of the gland by the tumor. The high calcium was due to calcium leeching out from my bones. I had the tumor removed a year ago.
Be sure to make sure the doc orders a bone density scan too.
Kathy
~Kathy~5'7.5"~lap RNY~05/20/2005~ 279/276/244/160/148/185 (high/consult/preop/goal/low/current)~Rich~6'5.0"~open RNY~08/05/2004~>500+/450/437/250/239/320(high/consult/preop/goal/low/current)
I just wrote this BIG detailed explanation of this and....... my computer froze. BUMMER! 
I'll see if I can summarize. If you go to Yahoo Grads, you'd see this is a universal issue, whether RNY or DS. And most docs don't even test this if you don't ask.
Our docs launch their proximal RNY on 10,000 units of D per day and distals on 100,000 ! We use dry form D3. Either 2 of the 5000 or 2 of the 50,000.
The rx D is vit 2 in oil. We malabsorb fats/oils to a degree (which is why we don't get it from food) AND we are unable to convert D2 into D3, the only form the body recognzes. So, your 50,000 of THAT will not deliver what you think. It will be a slow process.
TOXIC is not what is taken in (since we are malabasorbing it ANYWAY), but what is in the blood sustained over a period of time. And then, very, very high. Touching "too high" and then adjusting is not toxic.
Many labs still show 20-57 as a D range. That makes 40 very nice. When mine was 40, my PTH was 40, also considered nice.
Newer ranges for D, however, are 32-100, which means we shoot for 60-70. With that range, even 100 is only sorta high, not too high.
As I moved my D to 50, my PTH was 35. When I got D to 60, PTH was 30. Now D is 70, PTH is 20. And my calcium is still between 9.0 and 9.4, right where I want it.
For us, at 12 & 13 yrs and many labs to practice with, at current lab ranges, we take 25K a day (that's 5 of the 5,000) and I take 2 of th 50's per week, Don takes 3. That has held steady for the last 2 sets of labs. But each person needs to develop their own formula.
As for your 50k a day of rx, it's not going to work very quickly. Here, if I see low D, we do 50-100K per day, depending on the numbers of D & PTH, and test in 30 days. It it SNAPS up, we cut back. If it is only creeping slowly up, we continue and test again at 90 days. It's so different for each person.
For many years, we had to try to adjust our doses with the little 400's (also dry D3), but taking 12/day still wasn't doing it. Finally found the high dose ones and got things really nice, not just borderline.
So, your 2 questoins, has it happened to anyone? Pretty much everyone, tho, as I say, many ppl will never have these levels tested, don't know it because they don't get their own copies of labs. And toxic is a sustained level in the body, left unchecked.
I'll see if I can summarize. If you go to Yahoo Grads, you'd see this is a universal issue, whether RNY or DS. And most docs don't even test this if you don't ask.
Our docs launch their proximal RNY on 10,000 units of D per day and distals on 100,000 ! We use dry form D3. Either 2 of the 5000 or 2 of the 50,000.
The rx D is vit 2 in oil. We malabsorb fats/oils to a degree (which is why we don't get it from food) AND we are unable to convert D2 into D3, the only form the body recognzes. So, your 50,000 of THAT will not deliver what you think. It will be a slow process.
TOXIC is not what is taken in (since we are malabasorbing it ANYWAY), but what is in the blood sustained over a period of time. And then, very, very high. Touching "too high" and then adjusting is not toxic.
Many labs still show 20-57 as a D range. That makes 40 very nice. When mine was 40, my PTH was 40, also considered nice.
Newer ranges for D, however, are 32-100, which means we shoot for 60-70. With that range, even 100 is only sorta high, not too high.
As I moved my D to 50, my PTH was 35. When I got D to 60, PTH was 30. Now D is 70, PTH is 20. And my calcium is still between 9.0 and 9.4, right where I want it.
For us, at 12 & 13 yrs and many labs to practice with, at current lab ranges, we take 25K a day (that's 5 of the 5,000) and I take 2 of th 50's per week, Don takes 3. That has held steady for the last 2 sets of labs. But each person needs to develop their own formula.
As for your 50k a day of rx, it's not going to work very quickly. Here, if I see low D, we do 50-100K per day, depending on the numbers of D & PTH, and test in 30 days. It it SNAPS up, we cut back. If it is only creeping slowly up, we continue and test again at 90 days. It's so different for each person.
For many years, we had to try to adjust our doses with the little 400's (also dry D3), but taking 12/day still wasn't doing it. Finally found the high dose ones and got things really nice, not just borderline.
So, your 2 questoins, has it happened to anyone? Pretty much everyone, tho, as I say, many ppl will never have these levels tested, don't know it because they don't get their own copies of labs. And toxic is a sustained level in the body, left unchecked.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
I became vitamin D deficient this year-I am 2 years out from surgery. I have done some reading on Vitamin D deficiency following weight loss surgery and the dose that was prescribed-50,000 units per day is wrong. It is supposed to be 50, 000 units per week (or 1 pill once a week) for 6-8 weeks. I took that dose for the weeks that it was prescribed, and then had a repeat level done. I am still low, so am back on another 6 week course. You should question the doctor to see if maybe they just wrote it wrong on the Rx. I asked my doctor if I should have a PTH level drawn and she didn't think I needed it, but I still wonder about that. Have you developed any other deficiencies? I am now on B12 shots, and I think I may be Vitamin K deficient now, but have not had that confirmed, just suddenly developed a lot of bruising. I haven't been on the board for a very long time, so would appreciate any other comments concerning vitamin deficiencies. Thanks, Chris
R C
on 5/29/07 1:13 am - IA
on 5/29/07 1:13 am - IA
The pharmacist also questioned the Dr on the dosage and they said that due to the malabsorbtion issue and the fact that I am so deficient for it to be showing up that the 50,000 a day is the recommended dosage for a gastric bypass. They actually diagnosed me throught the PTH being elevated. Everything else is normal at this time. Thank you for your information Kourtney
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