Traditionally most people have thought that to have a diagnosis of hyperparathyroidism or primary parathyroid disease you had to have a high level of calcium in the blood.
This is generally true.
However, there is a small group of patients who's calcium levels can be in the normal range yet they still have the disease. It is important to remember that a normal range only ever encompasses 95% of the population. So some people (2.5% of the population) are going to be above and the similarly some (2.5%) will be below the lab standard values.
Blood test result must always be taken in conjunction with the symptoms and therefore the reason for doing the test in the first place.
Reasons for calcium levels being 'normal':
1. Levels fluctuating naturally day to day around the top end of normal so sometimes being inside normal range.
2. Low levels of vitamin D
3. High levels of calcium excretion by the kidneys therefore continually flushing calcium out of the body
4. Drug medication e.g., bisphosphonates, alendronic acid
So how can the diagnosis be confirmed. Mainly by careful analysis of a series of blood and urine tests, consideration also being given to how these fit with symptoms.
Supporting evidence can be gained from bone density scans, parathyroid imaging etc.
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