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ParathyroidAtlanta, 1472 Montreal Road Suite 303, Tucker, GA (2026)

02/02/2026

What’s All the Hype About Vitamin K2?

Vitamin K2 has been getting more attention lately in relation to hyperparathyroidism, calcium, and vitamin D supplements, especially in conversations about bone health and calcium metabolism. Interestingly, despite a growing amount of information available online, vitamin K2 still lives mostly in the background when it comes to mainstream, peer-reviewed medical literature.

There are a few reasons for that. One is practical: vitamin K2 is not patentable in any meaningful way, which means there is very little financial incentive for large pharmaceutical companies to fund expensive clinical trials. As a result, you won’t see vitamin K2 featured prominently in the major journals the way you might see a new drug or device.

Another issue is that we don’t have a clearly established recommended daily allowance (RDA) for vitamin K2. Different populations consume very different amounts through diet, and the research hasn’t yet settled on a single “correct” dose. Complicating matters further, there is no widely available, reliable blood test to measure vitamin K2 levels. That makes large-scale studies harder to design and interpret.

It’s also important to clarify a common point of confusion: vitamin K2 is not the same as vitamin K1. Vitamin K1 is primarily involved in blood clotting and is what most people think of when they hear “vitamin K.” Vitamin K2, on the other hand, plays a different role—helping direct calcium to where it belongs, particularly into bones and away from soft tissues. Because they share a name, the two are often lumped together, but functionally they are quite distinct.

In my own practice, I have been recommending the addition of vitamin K2 alongside calcium and vitamin D for many years, particularly in patients concerned about bone health and calcium balance. Only more recently have other parathyroid experts begun to publicly emphasize the same approach.

Based on the available evidence and clinical experience, my personal recommendation for vitamin K2 (MK-7) supplementation is 200–300 micrograms daily. While this is not an official guideline, it reflects what I believe to be a reasonable and safe range for most adults.

As with many nutritional supplements, vitamin K2 sits at the intersection of emerging science and clinical judgment. The absence of large trials does not mean it lacks value—it often means the system has little incentive to study it.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your specific situation before starting any new supplement.

01/20/2026

What if my scans are normal, but my lab work is abnormal?

It is quite common for an endocrinologist to confirm a diagnosis of primary hyperparathyroidism with lab work and then order one or more scans to look for an abnormal gland. It is important to understand that it is not necessary to see an abnormal gland on imaging before an operation to know that you have primary hyperparathyroidism. But it seems that endocrinologists tend to want to “hedge their bets” before referring a patient for surgery. In addition, there are many surgeons who don't feel comfortable considering surgery without having a scan that shows a single abnormal gland.

The most experienced parathyroid surgeons feel quite comfortable proceeding with surgery even if scans are normal. They know that if the lab work confirms the diagnosis, then they will be able to identify the abnormal gland or glands at surgery, regardless of the scan findings. The scans are quite helpful as a roadmap in preparation for surgery. But the imaging should not be the determining factor.

Why do scans sometimes look normal? Parathyroid glands are tiny and sit close to the thyroid. Normal glands are almost never seen, and a small overactive gland may blend in, or it may sit behind the thyroid or lower in the neck where it’s hard to see. Ultrasound is also operator-dependent: subtle findings can be missed by people who do not perform or read these tests often. An expert review can sometimes spot clues that others overlook. Although an abnormal parathyroid gland might not be seen on a sestamibi scan if it sits behind the thyroid (its usual location), it is hard to miss if it sits somewhere else. It is important for the surgeon to know if an abnormal gland is in an ectopic location, because those are the ones that might not be found even by an experienced surgeon. As long as the sestamibi scan doesn't show an abnormal location for the parathyroid gland, the surgeon can confidently go ahead with surgery, even if the scan is read as normal.

Bottom line: Don’t delay treatment you need while waiting for a scan to “light up.” If your labs confirm primary hyperparathyroidism, talk with a surgeon who treats this every week and can walk you through cure rates, risks, and next steps for you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

01/19/2026

“My Endocrinologist says I have primary hyperparathyroidism, but he wants to watch it and not refer me for surgery. Why is that?”

The history of parathyroid surgery is pretty interesting. It started over a century ago, long before we had the advanced testing we use today. Back then, there was no way to measure parathyroid hormone (PTH) levels—only serum calcium could be tested. Patients often showed up with severe bone disease or kidney stones. Without a PTH test, doctors had to rule out every other possible cause of high calcium before suspecting a parathyroid problem. Endocrinologists became the go-to specialists for sorting through all those possibilities. Only when every other cause was eliminated would they conclude an overactive parathyroid gland was to blame, and that’s when a surgeon got involved.

Fast forward to today, and things are much simpler. We have a quick blood test to check intact PTH levels. If you have four normal parathyroid glands, they won’t overproduce PTH just because your calcium is high for another reason. Now, the first step when calcium is elevated is to check PTH. If it’s not suppressed, the diagnosis of primary hyperparathyroidism can be made right away. In fact, if you’re generally healthy and your calcium is consistently high, chances are good that’s the issue—so it’s smart to check this first.

Still, many primary care doctors send patients with high calcium to an endocrinologist, and some endocrinologists keep running through all the old possible causes even when it’s unnecessary if the PTH is already too high. They might diagnose primary hyperparathyroidism but downplay it, telling the patient, “It’s not that bad, let's just follow it”.

This likely comes from a time when parathyroid surgery wasn’t as safe or routine as it is today in skilled hands. They may not realize how symptomatic these patients can be, even when calcium and PTH levels aren’t “that high.” The truth is, parathyroid surgery is highly effective and very safe when performed by experienced surgeons. Most people with primary hyperparathyroidism have symptoms that can improve, often significantly, after a straightforward operation.

Maybe your endocrinologist ordered scans to locate an abnormal parathyroid gland, but they came back negative. So, what happens next? Stay tuned.

11/07/2025

“My calcium and PTH are high, but my vitamin D is low. Is vitamin D the problem?”

This is a very common mix-up. A true vitamin D deficiency does not cause high calcium. In fact, low vitamin D usually lowers or keeps calcium normal. When your parathyroid hormone (PTH) is high from primary hyperparathyroidism (PHPTH), it stimulates the kidney to convert vitamin D into its active form. The usual lab test measures 25-OH vitamin D (the “regular” vitamin D). Because your body is converting it into the active form, the 25-OH level can look low—like fuel being used up. That low number often reflects consumption, not a primary vitamin D problem.

Why does PTH do this? High PTH tells your intestines to absorb more calcium (through active vitamin D), your kidneys to save more calcium, and your bones to release calcium. In a healthy person, PTH rises when calcium is low to push it up. But in PHPTH, PTH is inappropriately high, so calcium stays too high.

If you have PHPTH plus low vitamin D, taking extra vitamin D can sometimes make you feel worse, because it adds “fuel” that helps the gut pull in even more calcium—pushing your blood calcium higher. That’s why the first step is not automatically taking big doses of vitamin D.

What to do instead: See an experienced parathyroid surgeon to confirm the diagnosis and discuss treatment options. After successful surgery (removal of the abnormal gland), it’s often appropriate to supplement vitamin D to rebuild bone and restore healthy levels—under your clinician’s guidance.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

11/03/2025

What Are the Symptoms of Abnormal Parathyroid Hormone Levels?

Parathyroid hormone (PTH) helps your body keep calcium in a healthy range. When PTH is too high—most often from primary hyperparathyroidism (PHPTH)—your calcium level can rise. High calcium and high PTH can affect many parts of your body, so symptoms can seem unrelated at first. You might notice one or two symptoms—or many. Not everyone has all of them.

Common symptoms with elevated PTH (often from PHPTH):
• Fatigue and low energy
• Brain fog or trouble with memory and focus
• Bone loss (osteoporosis) or fractures
• Kidney stones or frequent urination
• Bone and joint pain or aches
• High blood pressure
• Anxiety or depression or mood changes
• Gastrointestinal issues like nausea, constipation, or abdominal discomfort

Why do these happen? High PTH tells your bones to release calcium, your kidneys to keep more calcium, and your intestines to absorb more calcium. Over time, this can raise blood calcium and stress bones and kidneys, which leads to symptoms like fractures or stones. Mood and thinking can also be affected.

If you have symptoms—or repeated high calcium on blood tests—talk with your clinician. Diagnosis is based on labs (calcium and PTH together), sometimes repeated more than once. If you’re taking biotin (found in many hair/nail vitamins), stop it for about a week before PTH testing because it can skew results. The decision for or against treatment is best made with an experienced parathyroid surgeon, who can review your case and discuss options. For primary hyperparathyroidism, surgery is the only cure.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

10/29/2025

“My calcium is always high, but my PTH is ‘normal.’ Can it still be hyperparathyroidism?”

Yes—it can. When your blood calcium is high, healthy parathyroid glands should shut down and make very low PTH. If your PTH is still in the “normal” range while calcium is high, that PTH is inappropriately normal—it isn’t responding the way it should. This pattern can still mean primary hyperparathyroidism (PHPTH).
To make the diagnosis, your clinician should look at calcium and PTH together, not each number alone. A high calcium paired with a PTH that is not suppressed (high normal or high) supports PHPTH. Sometimes one set of labs is not enough. If the results are borderline or confusing, it’s common to repeat testing—often more than once.

For the most useful information, it helps to draw calcium and PTH at the same time, ideally in the morning. This keeps conditions consistent and makes the results easier to compare. Also, be aware that biotin supplements (often found in hair/nail vitamins) can interfere with some PTH tests and make the result look lower than it truly is. If you take biotin, it’s best to stop for about a week before testing (ask your clinician first).

Finally, decisions about testing and treatment are best made with an experienced parathyroid surgeon. They can review your history, symptoms, medications, and lab trends to confirm the diagnosis and discuss whether surgery is right for you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

10/13/2025

“My scans were normal—do I have to wait to see which gland is abnormal?”

Short answer: No. You can still be a good candidate for surgery even if your sestamibi scan and ultrasound look normal. Primary hyperparathyroidism (PHPTH) is diagnosed by your blood tests—a high calcium with an inappropriately high parathyroid hormone (PTH). Ultrasound and sestamibi can help plan surgery, but they are not required to make the diagnosis.

Why do scans sometimes look normal? Parathyroid glands are tiny and sit close to the thyroid. Normal glands are almost never seen, and a small overactive gland may blend in, or it may sit behind the thyroid or lower in the neck where it’s hard to see. Ultrasound is also operator-dependent: subtle findings can be missed by people who do not perform or read these tests often. An expert review can sometimes spot clues that others overlook.

Most important: the decision for or against surgery should be made with an experienced parathyroid surgeon. High-volume surgeons know how to plan an operation even when imaging is negative. Their goal is to cure the disease safely, with the lowest risk. They will match your labs, your symptoms, and any imaging to choose the best approach. If a scan later helps localize a gland, great—it can refine the plan. But a “perfect” scan is not a must-have before surgery.

Bottom line: Don’t delay treatment you need while waiting for a scan to “light up.” If your labs confirm PHPTH, talk with a surgeon who treats this every week and can walk you through cure rates, risks, and next steps for you.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

10/08/2025

“They saw a thyroid nodule on my ultrasound—should I be worried?”

If you’re being checked for primary hyperparathyroidism (PHPTH), you might have an ultrasound of your neck. Good news: an ultrasound is not needed to diagnose PHPTH. Diagnosis comes from your blood tests—a high calcium with an inappropriately high parathyroid hormone (PTH). That said, ultrasound can help your surgeon plan the safest and smallest operation.

It’s common for the ultrasound to show a thyroid nodule. Thyroid nodules are very common in adults and most are benign. Many do not need more testing. If a nodule looks suspicious or is large, your doctor may suggest a fine-needle aspiration (FNA) biopsy. This is a quick office procedure that helps decide next steps.

When we do surgery for PHPTH, we rarely remove incidental thyroid nodules at the same time. Why? Because the main job is to fix the parathyroid problem first, with the least risk. If a thyroid nodule truly needs attention, it can be handled either during the parathyroid surgery or separately, after careful review.

Also, sometimes a “nodule” that seems to be in the thyroid is actually an enlarged parathyroid gland sitting right next to it. Your surgeon will compare the imaging with your labs and, if needed, other scans to tell the difference.

Bottom line: focus on getting the right operation for PHPTH the first time. Choose an experienced parathyroid surgeon—someone who does this often, can explain their cure rates, and has a clear plan if a nodule shows up on imaging.

This information is educational and not a substitute for medical advice. Talk with your own clinician about your situation.

08/11/2025

Catching a Silent Condition: How Routine Tests Changed PHPT

You could feel perfectly healthy, yet have a condition quietly affecting your bones, kidneys, and heart. That’s the case with many people who have primary hyperparathyroidism (PHPT).
PHPT happens when tiny glands in your neck make too much parathyroid hormone (PTH), sometimes raising calcium in your blood. Left untreated, it can cause bone loss, kidney stones, and even heart problems.
Not long ago, PHPT was usually found only after people became very sick—often with severe fatigue, brittle bones, or painful kidney stones. But the story has changed. Modern blood tests automatically check calcium levels, so most cases are caught early—before symptoms start.

In the U.S., about 233 out of every 100,000 women and 85 out of every 100,000 men have PHPT. Many of these are “asymptomatic” cases—people feel fine, but their bloodwork says otherwise. Or the symptoms may be attributed to just getting older, working too hard, menopause, or one of many other conditions. Typical symptoms include lack of energy, tiredness, muscle fatigue, memory and concentration problems, bone pain, excessive thirst and urination.

Doctors have also uncovered a form called “normocalcemic PHPT,” where calcium is normal but PTH is high. This was spotted when osteoporosis patients were tested for PTH, even without high calcium.

Early detection has made a big difference—years ago, extreme PHPT could be deadly in 60% of cases. Today, with treatment, that number is closer to 6%.

The only cure for hyperparathyroidism is surgical removal of the abnormal gland. Fortunately the operation can be done as an outpatient, with a very low risk of complications, and immediate return to a normal calcium level.

If you believe you could be silently suffering from hyperparathyroidism or want more information, please give our office a call (404-508-4320). We would be more than happy to get you into our office so you can get on top of your parathyroid health. Don’t suffer in silence, get your calcium and PTH levels checked today.

09/09/2024

“My routine lab work report shows the calcium level of 10.4, and that is just outside the range of normal. My doctor doesn't seem concerned. Should I be concerned?”

If this question resonates with you, and you have been looking online for information, you are in the right place. It is amazing to me how many patients end up searching for themselves online for more answers about their calcium level. The short answer to the question above is, “yes, you should look into this more”.

Routine lab work includes measurement of many electrolytes in the blood, including sodium, potassium, chloride, bicarbonate, among others. Calcium level is often checked routinely as well. It should be no surprise that all these electrolytes have some range of normal across an entire population. Our bodies can tolerate more variation in some of these electrolytes than others. Calcium happens to be one that needs to be more tightly controlled for the body to function optimally. The other electrolytes mentioned above might fall out of the “normal" more often, without creating a problem. The calcium level is controlled more tightly, and if the level is too high or too low, you can have more significant effects on the body even with comparatively minor extremes.

I think physicians have come to be almost expecting that some of these numerous lab values might be slightly out of range, so if the calcium level is “just a little high”, they may fail to recognize the special attention that should be paid to a high calcium level, as opposed to for example, a slightly elevated sodium or potassium.
So what does it matter if your calcium level is just a little high? Well, I think a good analogy would be a high performance engine that needs a tune up. The car can run just fine, but it cannot perform to its capability without correcting the high calcium level. Most patients with a high calcium level will have some symptoms as a result, such as weakness, fatigue, concentration or memory issues, bone pain, among others. And if left untreated for a long time, can result in organ issues, like poorly functioning kidneys, aggravation of atherosclerosis which is related to heart attacks and strokes, kidney stones, irregular heart rhythms, and the list goes on.

So if you have a high calcium level, or basically a calcium level that is repeatedly above 10, you should check to see if you have hyperparathyroidism. It is so simple to check. Simply have another serum calcium level drawn with a simultaneous intact PTH level. PTH, short for parathyroid hormone, is what your parathyroid glands produce in order to raise the blood calcium level. This is a very important function, but the PTH level should only be high if your calcium level is too low. If your PTH level is still high, or even in the upper normal range, when your calcium is high, It means that one or more of your parathyroid glands is simply working overtime, and is creating the problem of a high calcium level, just like a poorly tuned high performance engine.

If you are diagnosed with hyperparathyroidism, it means we can reliably predict that one, sometimes more, of your parathyroid glands is overproducing PTH. In experienced hands, a simple outpatient operation can find and remove that abnormal parathyroid gland and restore your calcium level to normal. Period. Just like that. We can be certain of that, just based on those test results.

So if you are looking for answers about a high calcium level, get your parathyroid function checked. And if you do have hyperparathyroidism, let us help you get your high performance engine back in tune! You can find more information at our website, https://www.parathyroidatlanta.com/.

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