Parathyroid Hormone (PTH) is a vital chemical messenger that maintains the delicate balance of minerals in your body. Understanding how it works—and why levels fluctuate—is essential for bone and kidney health.
Parathyroid Hormone (PTH) is produced by your four pea-sized parathyroid glands located behind the thyroid in your neck. Its primary job is to control the level of calcium in your bloodstream.
PTH also regulates:
Phosphate: A mineral that works with calcium.
Vitamin D: A hormone that helps you absorb calcium from food.
Where Are the Glands Located?
Most people have four parathyroid glands in the neck. Occasionally, they are found in the chest; these are referred to as ectopic parathyroid glands.
This is not so easy to answer.
The level varies quite a lot from lab to lab, and in different age groups. To make it more confusing different hospital/labs (and countries!) use different units. Here goes.
For many adults a normal PTH is about 1.5-7.0 pmol/L – or 10 to 65 pg/mL or 10–65 ng/L.
When your body detects low blood calcium, the parathyroid glands release PTH to bring levels back to normal through three main targets:
Bones: PTH triggers the release of stored calcium from your bones into the blood.
Kidneys: It tells the kidneys to stop flushing calcium out through urine and helps activate Vitamin D (Calcitriol).
Small Intestine: The activated Vitamin D then helps your gut absorb more calcium from your diet.
Once calcium levels are stable, the glands stop releasing PTH.
In patients with CKD, the kidneys cannot activate Vitamin D efficiently and fail to filter out excess phosphate.
This creates a “perfect storm” for PTH imbalance:
Secondary Hyperparathyroidism: Because calcium levels stay low in CKD, the parathyroid glands work overtime, pumping out high levels of PTH.
Renal Bone Disease (RBD): Long-term high PTH “steals” too much calcium from the bones, making them soft, weak, and prone to fractures.
High PTH (Hyperparathyroidism)
CKD (Stage 4-5): The most common cause of elevated PTH in kidney patients.
Vitamin D Deficiency: Without Vitamin D, your body can’t absorb calcium, forcing PTH to rise.
Gland Growth: In some cases, the glands grow too large and release hormone uncontrollably.
Low PTH (Hypoparathyroidism)
Post-Surgery: Damage to the glands during neck or thyroid surgery.
Autoimmune Conditions: When the body’s immune system attacks the parathyroid glands.
If you have CKD, managing your PTH is critical to preventing bone damage.
Key Treatments
Medications: Doctors may prescribe Calcium Acetate (phosphate binders), Alfacalcidol (active Vitamin D), or Cinacalcet (a drug that tells the glands to stop making PTH).
Dietary Changes: Avoid high-phosphate foods like cheese, chocolate, and dark sodas.
Surgery: If medication fails, a parathyroidectomy (surgical removal of the glands) may be necessary.
Top Tips for Patients
Track Your Labs: If you are in CKD Stage 4 or 5, check calcium and phosphate every 3 months and PTH every 6 months.
Stick to Your Meds: Take your binders and Vitamin D supplements exactly as prescribed to keep your bones strong.
For more information on how kidney health impacts your bones, watch this video: Renal Bone Disease Explained.
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