Hyperthryoid and Hyperparathyroid Coexisting

[Bits44]

TSH has been consistently between .4 and .8 for the last 18 months, with symptoms of hyperthyroidism for the last 3 to 4 years. T4 is usually at the upper end 1.7 or 1.8, and reverse T3 has been high with T3 high normal. Excessive sweating, racing heart, moderate high blood pressure, anxiety, increased thirst and appetite were symptoms the past 4 years. More recently symptoms have changed to tachycardia, internal tremors, convulsive feelings, and fatigue, along with increased appetite with unwanted weight loss. Ultra sound which showed 5 nodules. 2 tiny right lobe nodules 4x3x5mm, and 3x2mm. One large 11x10x7 mm in mid right lobe, and a prominent 8x7x6mm in lower right pole (this one choked me during biopsy). Also one 1.3x1.3x.8cm on left lobe. Single left mid pole and lower right pole nodules were biopsied and were benign.

The past year I have had calcium levels of 10.3, 10.2, and consistently 9.9. It dropped to 9.1 at one point. Urine Calcium is 352, highly elevated for a very low calcium diet. Intact PTH has always been normal, although it has been higher lately in upper 40's and 50's. Vitamin D was 30 last year, and I reacted very poorly to supplementation. My body converted most of the D3 spray to calcitrol and it went to a level of 115 (72 is upper end I believe). I have just crossed over into the osteopenia range in my neck -1.1, and am .1 away in my lumbar on a Dexa Scan. Surgeons, Primary Care and Endo have all told me I have hyperparathyroidism, then I don't have it. Then I have it, then I don't. Surgeons have agreed recently to do a mini parathyroid surgery to deal with both.
All day long it feels like I'm stuck in the calcium feedback loop. High PTH then high calcium, hyperthyroid storm (calcitonin) then low blood calcium. All day I alternate between stiff muscles and jello. Confusion and hyperactivity. Abnormal energy and fatigue. Is it possible that the diagnosis of hyperparathyroidism has been more difficult because of hyperthyroidism?

[Mark Lupo, M.D.]

It looks like early primary hyperparathyroid most likely.
The thyroid levels are normal (TSH 0.4-0.8 are not hyperthyroid).
You have small thyroid nodules (all are <1.5 cm) that are not likely to cause compressive symptoms and would not need to be removed unless FNA suspicious or your doctor feels it is necessary.

[Bits44]

Thanks for your prompt reply.

I didn't mention I've had 3 kidney stones, all small and passed fairly easily.
When I eat calcium or vitamin d foods I have massive fatigue and have to urinate all day long. So basically I avoid them. I don't have food allergies to dairy. I have been tested.

Also, I didn't mention I'm only 36. We lived under a 30,000 volt power tower for 5 years until a recent move, and were exposed to a lot of radiation. Also, during this period I developed a vestibular disorder in the right ear. The calcium and fluids in my ear are moving around and changing all day long, as is my equilibrium.

The lower right pole thyroid nodule (maybe the scar tissue from the biopsy) or the potential parathyroid tumor feel like they are compressing something in the right neck. I have a choking sensation multiple times per day, and literally hold my neck for hours during the day.

Thanks again for your input.