Vitamin D Deficiency and Hyperparathyroidism

A new hot topic in Endocrinology relates to the high incidence of unsuspected Vitamin D deficiency in patients with high blood calcium and hyperparathyroidism. Traditionally, patients with blood calcium levels in excess of 11.0 or long term complications of hyperparathyroidism including kidney stones, advancing osteoporosis or stomach ulcers are sent directly to surgery for removal of enlarged parathyroid glands (there are 4 parathyroid glands located low in the neck, just behind the thyroid gland, usually one gland is overactive and enlarged with hyperparathyroidism). At Fort Lauderdale Endocrine Surgery, more than 30% of patients referred to us for minimally invasive parathyroid surgery turn out to have unexpected Vitamin D deficiency!!! Given the directness of the sun's rays and the year-round exposure in Florida, we had been perplexed by this finding until we came to realize that the dermatologists have done such a good job of promoting sunscreen use that many Floridians do not get enough unscreened sun exposure to manufacture Vitamin D in their skin. In any event, recognition of Vitamin D defiency is important for the patient with hyperparathyroidism because some patients will normalize their parathyroid hormone levels and improve their blood calciums simply with a vitamin D supplement. We offer a course of Vitamin D3 replacement prior to scheduling the patient for minimally invasive surgery in hopes that we can prevent an unnecessary procedure. The only contraindications to Vitamin D3 supplementation are a blood calcium in excess of 11.5 or active kidney stone formation. We typically treat for 3-4 months with a proprietary Vitamin D3 preparation (not all vitamin D3's are equally potent as the FDA does not regulate nutritionals) and then re-assess to see if surgery is still necessary.
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