Parathyroid and Calcium Subclinical Patterns

At Origins Incubator, we love digging into interesting topics that we all face as physicians. For example, we recently looked at sub-abnormal or slight abnormalities in things, such as calcium and parathyroid. 

Spending Time with the Patient

One of the major things from this discussion is just how much good we do when we actually stop and spend time with the patient as per the Origins’ Membership Model.  If we are talking about the standard model out there that, statistically speaking, provides about seven minutes per patient visit, it’s very difficult for the clinician and the patient to sit down and look at data in detail, to see more nuanced patterns. You must be willing to spend ample time with your patient to understand the what is going on and hopefully achieve their personalized path to wellness for that individual.

Slightly Elevated Calcium & Parathyroid

This can be really clear in terms of, for example, calcium that is either high, normal, or maybe right at the upper end of normal, one point above. And then from there, when we think about elevated calcium, of course, the next step is to look at parathyroid.  We also examined some case studies in which the parathyroid was to the higher side of normal and not low. The pattern, of course, we would expect when calcium is high that would suppress parathyroid, so we don’t further decrease bone breakdowns, increase calcium, increase uptake, and decrease excretion. It's crucial to determine these potential patterns.

Early Warning Signs

What about this pattern-- when calcium is very borderline high, but parathyroid is within the reference range, when really it should be suppressed with that type of level? Our discussion centered on when we really sit down and talk to the patient, how it is appropriate to refer out from there, to make sure there is no hyperplasia, or were some type of lesion there. We had a discussion around this and how a number of colleagues had found evidence of lesions there. Some mentioned discovering these early warning signs and were even able to prevent things like a parathyroid cancer because they took the time. In Origins Incubator, when we teach the membership model, this is largely what it’s about: having that time for the patient to really be able to look at things like that.

Other Reasons

We also discussed how there are other reasons that you could see an increase in things, like calcium without suppression or because of hyperplasia. That will happen when there’s been a long-term deficiency in vitamin D or calcium. If that person had had a deficiency and then had gone on to maybe treat or someone who has had a deficiency of Vitamin D, that can cause the tissue in the parathyroid to get larger and also to produce more parathyroid hormone. 

Conclusion

This discussion was extremely helpful as we looked at some of these trends and really thought about, when we are digging into these functional reference ranges, what we’re able to elucidate.  It’s very clear that our most powerful medicine is having that time with the patient and really getting to know whom we are working with and following the premise of first “Do no harm.”

It is such a pleasure to work with Origins in terms of not only the clinical application, but also a model that really allows for optimal patient/physician rapport.