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Information on the latest vitamin D news and research.

Find out more information on deficiency, supplementation, sun exposure, and how vitamin D relates to your health.

New meta-analysis: Vitamin D supplementation of no concern in mild primary hyperparathyroidism

A new meta-analysis is out that says vitamin D supplementation is an okay measure to take in primary hyperparathyroidism.

Primary hyperparathyroidism (PHPT) is a condition where the parathyroid glands develop an adenoma, which is a non-cancerous tumor. This adenoma causes your parathyroid to produce too much parathyroid hormone, which can lead to a condition where you have too much calcium in your blood (hypercalcemia) and can compromise your bone health and cause osteoporosis.

Since vitamin D can increase your ability to absorb calcium in the gut, doctors are usually cautious to prescribe or recommend vitamin D, worried that it might tip your calcium balance a little too high.

But are these concerns unfounded? Last July, I reported on an observational study that looked at 28 patients with mild PHPT who supplemented with vitamin D. They found no increase in calcium levels in the patients and decrease in parathyroid levels, suggesting that vitamin D is not only safe, but maybe necessary.

Recently, a meta-analysis was published in Clinical Endocrinology that looked at 10 studies similar to the one in July. The strength in performing a meta-analysis is that we can pool more patients together and feel more confident in its results compared to a small study.

The researchers gathered the 10 studies after searching the Medline, Embase and Cochrane databases. All of the studies were observational since there are no randomized controlled trials examining the issue. However, the observational studies did look at patients who were supplementing with vitamin D.

In total, these studies involved 340 mild PHPT patients that supplemented with vitamin D. The duration of the supplementation/observation period in the studies ranged from 1.25 months to 12 months.

What did the researchers find? Were these PHPT patients at risk of high serum calcium? Here were the findings:

  • Mean serum vitamin D levels increased by 22.1 ng/ml. Eight of 10 studies brought vitamin D levels above 30 ng/ml.
  • There was no change in serum calcium levels, the major concern in PHPT (-.08, 95%: -0.2, +0.03, P = 0.2)
  • 227 patients took vitamin D for more than 6 months. When the researchers looked at incidence of hypercalcemia (high calcium) in these patients, only 5 patients developed high serum calcium. Therefore, the incidence of hypercalcemia was 2.2% with vitamin D supplementation in PHPT subjects.
  • There was a significant reduction in PTH levels by 3.5 pmol/L (-5.8, -1.2, P = 0.003).

The researchers concluded,

“Vitamin D replacement in mild PHPT with coexistent vitamin D deficiency reduces parathyroid levels significantly without exhibiting hypercalcemia or hypercalciuria. There is certainly a need for a large RCT with vitamin D replacement in asymptomatic PHPT with coexistent vitamin D deficiency with long term follow up to address the many questions which remain unanswered.”

The authors further pointed out that researchers in the past often cautioned against taking vitamin D in PHPT, however this is based on expert opinion and is not evidence-based, as shown in this meta-analysis. It appears at least in mild PHPT, vitamin D supplementation is safe over 97% of the time.

Also keep in mind that these 10 studies looked at mild PHPT, so we still need more research in moderate and severe cases. And, we could use randomized controlled trials for mild, moderate and severe cases.

Source

Shah VN et al. Effect of 25 (OH) D replacements in patients with primary hyperparathyroidism (PHPT) and coexistent vitamin D deficiency on serum 25(OH) D, calcium and PTH levels: A meta-analysis and review of literature. Clin Endocrinol, 2014.

  About: Brant Cebulla

Brant Cebulla was a staff member for the Vitamin D Council from May 2011 to April 2014. He has keen interests in nutrition and exercise.

3 Responses to New meta-analysis: Vitamin D supplementation of no concern in mild primary hyperparathyroidism

  1. A few people with Hyper-parathyroidism have had problems with larger amounts of Vitamin D, so caution is advised.

    If you have Hyper-parathyroidism:
    Maybe start with a blood test of your blood Vitamin D level to establish a baseline figure
    Then take 1,000 IU per day of Vitamin D3 for a week and watch for symptoms
    Then increase to 2,000 IU per day for the next week
    Then increase to 3,000 -> 4,000 IU or more in the following weeks
    Then re-test to find your resulting Vitamin D blood level
    ( 1,000IU = 25 micrograms / 4,000IU = 100 micrograms )

    Download the “Call-To-Action” from http://www.grassrootshealth.net
    This will better advise you and your doctor about your target blood levels
    ( 40-60 ng/mL in USA or 100-150 nmol/L in Europe & RoW )

    Some Thyroid problems may be related to Adrenal Fatigue, so these need to be sorted before you start taking Vitamin D

    I recently gave a talk about Vitamin D to a UK Thyroid support group
    You can see the presentation and listen to the talk at: http://www.vitamindwiki.com
    Search for Thyroid or: http://is.gd/thyroidrg

    Please download the talk and send me feedback about what has worked for you

    Rufus Greenbaum

    .

    • Brant Cebulla says:

      Rufus,

      I’m not familiar with any evidence that people with thyroid problems should use caution in taking vitamin D. Do you have any sources?

      People with parathyroid problems, on the other hand, need to consult their doctors before taking vitamin D, especially for the condition primary hyperparathyroidism, as explained in this blog.

      Cheers,
      Brant

  2. This doesn’t deal with the cautions needed in taking vitamin D in people who have primary hyperparathyroidism.
    It offers a theory. That an important cause of primary hyperparathyroidism in some pepole which results in one or more adeonomas is decades of vitamin D deficiency which leads to stimulation of the parathyroids glands which have to work “overtime” to produce Parathyroid Hormone (to keep the vitamin d level at a safe level). The hyperplasia at some point becomes autonomous and develops into an adenoma. I’m not saying that vitamin D would cure it, but I am proposing the theory that prevention of vitamin D deficiency at an early age would prevent primary hyperparathyrordism in those that may be genetically susceptible.
    Robert Baker MD