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  • Writer's pictureSallie Powell

Hyperparathyroidism, Vitamin D and Magnesium

Updated: Jun 18

We all know that a huge percentage of the population has issues with low vitamin D. A lot of people know that some doctors have been telling patients with hypercalcemia, that they shouldn't take vitamin D at all because it will increase calcium. That's not strictly true. We don't recommend large doses of vitamin D with hypercalcemia. In fact, we don't recommend very large doses of vitamin D for anyone. We know the vitamin D groups will disagree, and that they recommend larger doses based on body weight.


  • How many doctors tell patients that vitamin D is fat soluble. Do they even know?

  • How many doctors know that magnesium is essential in the metabolism of vitamin D, and that taking large doses of vitamin D can induce severe depletion of Magnesium? Adequate magnesium supplementation should be considered as an important aspect of vitamin D therapy.

  • How many doctors consider that calcium might be within the normal range in the presence of elevated PTH due to insufficient magnesium?

People with hypothyroidism, diabetes, fibromyalgia, malabsorption, will also very likely have lower magnesium.


Many of us know that the serum blood test for magnesium only represents about 1% of magnesium stored in the body. That doesn't necessarily mean its a pointless blood test, far from it. Not only is it a really cheap blood test for the NHS, but low in the range (below 0.82) is reported to increase the risk of ischemic strokes by over 60%. We see many who do get magnesium tested who are told by doctors that their level is fine even if its marginally above 0.7 (0.7-1.00) which isn't true, but how many doctors actually know how to interpret population reference ranges? Of course, we would like to see the RBC magnesium test available and 24 hour urinary magnesium excretion test; https://www.sciencedirect.com/topics/medicine-and-dentistry/magnesium-excretion#:~:text=The%20fractional%20urinary%20excretion%20of,drop%20in%20plasma%20magnesium%20concentration. Those taking PPIs are at risk of hypomagnesemia (and of course it reduces calcium also).

'Proton pump inhibitors (PPIs) are commonly used in clinical practice for the prevention and treatment of peptic ulcer, gastritis, esophagitis and gastroesophageal reflux. Hypomagnesemia has recently been recognized as a side effect of PPIs. Low magnesium levels may cause symptoms from several systems, some of which being potentially serious, such as tetany, seizures and arrhythmias. It seems that PPIs affect the gastrointestinal absorption of magnesium. Clinicians should be vigilant in order to timely consider and prevent or reverse hypomagnesemia in patients who take PPIs, especially if they are prone to this electrolyte disorder.' https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3782221/#:~:text=Hypomagnesemia%20has%20recently%20been%20recognized,the%20gastrointestinal%20absorption%20of%20magnesium.


Low levels of magnesium stimulate parathyroid hormone secretion, as do low levels of vitamin D and calcium. Going into parathyroid surgery with low levels of magnesium can induce a paradoxical block of PTH. We have seen several such cases, where patients are admitted back into A&E soon after being discharged from surgery, where doctors have been left baffled by hypocalcemia and low PTH. Administering IV magnesium, restores equilibrium. Whilst our members are educated about the necessity of magnesium, we are concerned for patients who haven't found us. We would appreciate doctors becoming more aware about magnesium and testing it as routine when testing calcium, PTH, and vitamin D. Information studies about magnesium can be found in abundance online. Please find some time to educate yourselves about the benefits and importance of magnesium. Here are a few examples; 'Association between hypomagnesemia and severity of primary hyperparathyroidism: a retrospective study': https://pubmed.ncbi.nlm.nih.gov/34416890/ 'Serum Magnesium Measurements After Parathyroidectomy for Primary Hyperparathyroidism: Should It be Routine?' https://link.springer.com/article/10.1007/s00268-020-05425-1#:~:text=Serum%20magnesium%20decreased%20significantly%20following,%2Doperative%2C%20mostly%20mild%20hypomagnesaemia. Magnesium and the parathyroid: 'The serum levels of parathyroid hormone and magnesium depend on each other in a complex manner' : https://pubmed.ncbi.nlm.nih.gov/12105390/


'A patient with Crohn's disease receiving vitamin D and calcium had normal serum calcium levels when serum magnesium was low. Hypercalcaemia was precipitated when supplemental magnesium was given. The reason why serum calcium was initially normal is probably related to the effect of magnesium deficiency in reducing serum calcium level. https://pubmed.ncbi.nlm.nih.gov/3991404/#:~:text=Hypercalcaemia%20was%20precipitated%20when%20supplemental,in%20reducing%20serum%20calcium%20level.


'Optimal magnesium status is required for optimal vitamin D status. Both magnesium and vitamin D are important to the immune system independently. Together, they may be beneficial in COVID-19 infection because magnesium is necessary to activate vitamin D.'

'The adequate balance of magnesium and vitamin D is essential for maintaining the physiologic functions of various organs. Vitamin D helps regulate calcium and phosphate balance to maintain healthy bone functions.Skeletal muscles, heart, teeth, bones, and many other organs require magnesium to sustain their physiologic functions. Furthermore, magnesium is needed to activate vitamin D. Abnormal levels in either of these nutrients can lead to serious organ dysfunctions.' https://www.degruyter.com/document/doi/10.7556/jaoa.2018.037/html

It is important to know that magnesium shouldn't be taken at the same time as calcium, zinc or levothyroxine, but should be separated by 3-4 hours.

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Est. 02.09.2014

 Hyperparathyroid UK (HPT UK)

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