Is this Parathyroid Disease

[Bull B]

Sir/Maam, I have a question about parathyroid disease and I hope you can help me out.  I am a 40 year old white male, felt like in good health until now.  I have a history of kidney stones, the first bout came about 10 years ago and the latest bout this past year.  Dec 05/Jan 06 was diagnosed with several stones in the kidneys.  I had one big one and 3 or 4 smaller ones.  The Dr. said I needed surgery, so the first surgery was EWST--where they shock wave the stones.  Needless to say that didn't remove them all and I had to have 3 more total surgeries to remove the stones (all with the laser).  Collected some of the stones that passed and it was determined that the stones were 67% calcium oxylate and 33% calcium phosphate.  A CT scan after the surgery showed no stones. I then left Las Vegas for a new job in Denver in Mar 06.  Feeling pretty good.  After about a month here, I met with my new Primary Care Doctor--and did a entire physical for my new job.  Came back that I had a high calcium reading in my urine and related that I needed to do a 24 hour calcium collection which came back normal. In between times, because I had the past kidney stones, he referred me to an Endocronologist.  She she did another 24 urine test and a CT scan to check my kidneys.  This came back with a high calcium (360) reading and also a low citric acid count (57).  The CT scan was normal for no stones and my adrenals looked OK. In the next couple of months I was given another couple of PTH tests and blood calcium test--The first one came back with a PTH of 69--I think the the range is (10 to 69)--so mine was on the high side and then a fairly normal calcium level of 9.2 ( range of 8.5 to 10.5). The second test came back with upper high normal for both PTH and Calcium and also a DEXA bone scan which showed some pre-osteroperosis in the spine.  With all three of these factors she determined that I could have a bad parathyroid and ordered me a Sestambi Scan and also a ENT consult.  These two referalls are being done next week (4 Dec 06 and 11 Dec 06).I hope and pray that this parathyroid is causing me some of my health symptoms that I have been having for the past 8 months--and lately they have gotten worse:
Had a couple of panic attacks--Doctor prescribed some medication for the anxiety/depression--been off of them now for about two months( didn't feel good on them--but still feel anxious/depressed)
Loss of Energy--Feel tired all the time
Just don't feel good, feel nauseated quite a bit.
Insomnia--don't sleep very good and sometimes not at all.
Bones Hurt
Pain in Abdomen/Stomach discomfort
GERD/Acid Reflux
Headaches
Hard to keep Concentration--feel like I am in a fog-memory lapses
Have constipation mostly and then sometimes diarrehea--also did a colonoscopy which came back neg--only mid hemmorroids
Lately been having chills--flu like symptoms

Thanks for your time--if this is not the cause--I don't know where to go next!!

v/r

Mike B

[Kevin Pho, MD]

Difficult to say without evaluation.  However, with the PTH and calcium levels, I definitely would consider parathyroid disease.  I agree with the scan or ultrasound to localize the gland.  

A vitamin D level can also be done to evaluate other causes of an increased calcium level.

Regarding the wide range of symptoms, I would consider blood tests to evaluate the thyroid function levels.  

The GI and neurological complaints can be evaluated by a gastroenterologist and neurologist respectively.  Imaging the head with an MRI can be considered to evaluate intracranial causes.

These options can be discussed with your personal physician.

Followup with your personal physician is essential.

This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.

Kevin, M.D.
kevinmd_