High clacium, low vitamin D, normal PTH

[SML89]

Hi Dr. Lupo,

My Endo has me very worried. In a routine lab test ( I am type 2 diabetic plus have Hashimoto's) my calcium level showed 10.3. He had me repeat it a couple of months later and it showed 10.4. He also did a test for vitamin D 25-Hydroxy and my level is 23, Ionized calcium was 5.5, Serum Phosphorus was 3.9, and PTH was 23. Now he is sending me back for more lab tests, ACE level, PTH Related, and Serum protein electrophoresis. I know those tests are to look for multiple myeloma and I am very scared. Over the last 10 years of being diagnosed with Hashimoto's and type 2, I have had brain fog, no energy, muscle twitches, restless sleeping, GERD, weight gain, have a hard time concentrating, etc...and I just attributed all this to my type 2 and Hasi's.

I see many, many posts on here from people with the same symptoms as I have. I would love to have your opinion. I was really thinking I may have a hyperparathyroid  or an adenoma on one of my parathyroid's but with the normal PTH level, I am confused. With all the sypmtoms I have, it seemed like that was the direction my diagnosis was going to take. But now with the further testing, I am really worried. Could it still be a parathyroid adenoma with a normal PTH?

I have not yet had the new labs done, have to do this next week, with the endo visit the following week.

Thank you in advance for your opinion and advice.

[Bella1950]

Hi, I also had low Vitamin D, in the beginning, high blood calcium, high ionized calcium, and a totally normal PTH of 35, and I had surgery a few weeks ago, and they found 2 adenoma's, and I had 2 parathroid glands removed.  My Endo ruled out all of the above cancer's, and I was really worried, especially when nothing was showing up on scans, but finally a MRI caught a nodule in the "Area", so they did surgery, and were very surprised.  I had all of your symptoms.  Don't panic!  I found that just made my symptoms worse.  Waiting is so hard, but just try to remain calm if you can.  Also, during all of this my blood sugar went high, but is normal now. My calcium levels are now in the normal range, and PTH is still the same!!!  Hope this helps!  Bella1950

[Bella1950]

I had a ENT surgeon, and he has done several.  Actually, I had 2 surgeons in the room.  He called in another one durning my surgery, as he was concerned about something he saw on the Thyroid, and I had a scan before my surgery, so I knew I had 9 nodules on the thyroid gland.  They took out 2 lymph nodes also, and all tested OK.  My ENT does parathyroid surgery every week, so he does his job well.  My scar is about 1 1/2 to 2 inches at the most.  My surgeon did all the scans, and finally a MRI picked up one of the nodules, but not the second, so he did have a "road map"!  I had a very good experience with my surgery, and only needed tylenol in the hospital.  I stayed one night, and I did have a drain, because of the extensisve surgery they did, with the other things they removed, but they took it out 2 days later.  I actually went home with it in. I could talk fine, never even hoarse, swallow just fine, and really had no swelling.  A very easy surgery for me. With all they did, my surgery took about 1 hour.  I have to have my thyroid scanned every 3 months, and this is a wait and see thing.  My thyroid meds have been "Upped", and I will have my blood calcium drawn today.  The ENT surgeon, was very hesitant to do my surgery as I always had normal PTH levels, but after all was ruled out, and finally a nodule on a MRI he said he would go in to take a look!! My ENDO was positive, he would find 1 adenoma, and was shocked he found 2.  I have my pathology report, and there were 2!!! I worry about my thyroid, and the fact, that I still have symptoms, although many have left, and also, that when you have 2 parathyroid adenomas, your risk is higher for more, so I hope nothing is on the left side!! LOL  I just do one day at a time, and on parathyoid.com, they say some things can take 1 to 3 months to get better, that it takes time.  I had awful symptoms!  So, just relax, let them rule out all the "BAD" things, and don't worry.  It really is a easy surgery, and make sure to ask your surgeon how many of these he does.  My Endo sent me to this surgeon, and said he does all of them in this area, and the nurses at the hospital told me he does 3 to 4 a week.  So, I felt really good about it. Keep me updated!!  Bella1950

[SML89]

Thank you Bella and Dr Lupo, you have both eased my fears. I think my Endo is being overly cautious but I suppose it will be good to rule out the bad things. I never thought I'd be praying for an adenoma, but I am! That will be an easy fix, and I will be so releived when this is over and I begin to feel normal again. I have been experiencing so many side effects of having a parathyroid adenoma, I think I have every one of them!

Bella, did you have an Endo surgeon do your surgery or a normal surgeon? I have read alot about Dr. Norman in Tampa being one of the best and I also saw on the parathyroid.com website that so many surgeons don't know what they are looking for when they do this type of surgery and leave a huge scar. What was your experience?

thank you again!

[Mark Lupo, M.D.]

This is most likely primary hyperparathyroidism with normal PTH.  Usually the PTH is >30 in these cases, but I have seen many in the 20's. It is appropriate to screen for other causes, but this will likely end up being a parathyroid adenoma.