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Possible parathyroid problem with low-normal PTH?
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Questions in the Thyroid forum are answered by Mark Lupo, MD. Topics covered include Goiter, Graves Disease, Hyperthyroid, Parathyroid/Calcium Problems, Thyroid Cancer, Thyroid Nodules/Cysts, Thyroiditis, Thyroid & Pregnancy, Thyroid Stimulating Hormone (TSH), Thyroid Tests, and Thyroid Surgery.

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Possible parathyroid problem with low-normal PTH?

I am a 31-year old female with many of the symptoms of primary hyperparathyroidism (joint/bone pain, fatigue, memory/concentration problems, occasional muscle weakness, increased thirst/urination, occasional abdominal pain, nausea, and mild depression).  I have had gradually-increasing joint/bone pain for the past 7 years.

I have an elevated serum calcium with a vitamin D deficiency; however, my PTH is low-normal.  My primary care doctor and I are confused about what to make of this because the low-normal PTH does not support a diagnosis of primary hyperparathyroidism.

Over the past few weeks, the results of my bloodwork show:
Total serum calcium:  10.4, 10.4, and 10.2 mg/dL (three separate measurements, each about one week apart)
25-hyroxy vitamin D:  19.7 ng/mL
PTH: 12 pg/mL

Could this be a parathyroid problem?  I am waiting on results from an ionized calcium blood test and a repeat of the vitamin D test.  What other tests would you recommend?

I do not take any supplements, but I do consume about 80-100% of the recommended daily value of both calcium and vitamin D each day from fortified juice and almond milk.

I also have a high rheumatoid factor, but have seen a rheumatologist and was told it was not related to a rheumatological disease.  Could the presence of the rheumatoid factor antibody disrupt PTH measurements?

Any input would be very helpful.  Thank you!
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Would be suspicious w/ the slightly high calcium and symptoms but the PTH of 12 is not c/w primary HPTH.  Would retest PTH and make sure the specimen is frozen (ie, if left at room temp, the PTH will degrade and could be falsely low).  RF is not known to interfere to my knowledge.
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