Help Please

I'm back, just posted here last week under other. I just found out from my pcp that I need to see an endo. My blood work came back with a pth of 11 (a little low) calcium 9.6 and tsh 0.03. My RF was 11 being slightly below the positive range with a titre of 1:40. My pcp doesn't understand why my tsh has fluctuated so much over the past four years post thyroidectomy. A few months ago it was at 0.06. They are actually driving me nuts... with the constant med change. I feel like **** either way. Funny though, "I have no heart palpations!" "No weight loss either!"  
Does anyone know what could possibly be happening? I seen a rheumatologist who talked with my pcp believing it endocrine related and not ruling out a possible autoimmune problem.
I feel weak, fatigue, tingeling in my theighs and calves along with the feeling as though my muscles are moving around. I get this God awful pain in my right flank area in the back. (Ribcage area)
I just found out from my eye doc which would have been helpful before is that I have a history of thyroid eye disease.
Again, I would greatly appreciate it if someone had some insight. I also have had vitiligo for the past 27 years or so.

[stella5349]

I would get a full panel of tests on your parathyroids.

I see you had calcium - serum and ionized?
Vit D is needed
phosphorus too

Just a hunch - but I would elimated this if you can. Are you having acid reflex and if not personal - what is your age?

[maria19609]

I'm on vit D sup. Yes, they did the ionized and serum, ALK phosphorus is at 112, higher than the last blood draw. And yes, I get severe acid reflux. Why do you ask?

[maria19609]

Oh, by the way, my age is 48

[stella5349]

You are in need of further testing for hyper parathyroid disease.

Your tests titter a sub clinical staus and your symptoms mock a PTH issue.

Visit the parathyroid.com site for a ton of info.

You need to test/scan soon. Be your won advocant on this. Many docs will brush this off and you will suffer needlessly.

[maria19609]

What type of test/scan are you talking about? I'm so glad that someone out there is kind of helping me through this. There are guardain angels out there, "maybe your one of them!" :)

[Shari4]

Oh, believe me - Stella is surely an angel....... ;-)

[stella5349]

check out the parathyroid.com website. I really think it is so easy reading and it really digs into a lot of a person's symptoms and gives the person really hurting a way to get to know what they might be facing.

They scan I am referring is a sestamibi scan.

This is really long - but will tell you exactly what this scan does to Dx parathyroid abnormalities. Keep in mind - there are missed Dx's with using this scan. In some cases it actually does not pick up the abnormal functioning parathyroid - but if your calcium - plus symptoms coinside with an inconclusive scan - most parathyroid specialists will monitor this as a possible condition.

Here is the defination of this scan:

A sestamibi scan of the parathyroid gland is a nuclear medicine procedure which is performed to identify hyperparathyroidism (or parathyroid adenoma). Sestamibi is a nuclear radiopharmaceutical (methoxy-isobutyl-isonitrile) which is bound to the radioactive isotope Tc99m. Tc99m-sestamibi is taken up by both the thyroid gland and the parathyroid gland, but can also be taken up by enlarged thymus or lymph nodes within the neck, and is also used in nuclear myocardial perfusion imaging and in detection of very early stage breast cancer.

The principle of the procedure is that the Tc99m-sestamibi is absorbed at a greater rate in a hyperfunctioning parathyroid gland than in a normal parathyroid gland. This is dependent on several histologic features within the abnormal parathyroid gland itelf. Sestamibi imaging is correlated with the number and activity of the mitochondria within the parathyroid cells, such that oxyphil parathyroid adenomas have a very high avidity for sestamibi, while chief cell adenomas have some affinity but to a lesser degree, and clear cell parathyroid adenomas have almost no imaging quality at all with sestambi. Some researchers have also attempted to quantitate or characterize the imaging capabilities of parathyroid glands by the MDR gene expression. Approximately 60 percent of parathyroid adenomas may be imaged by sestamibi scanning. The natural distribution of etiologic causation for primary hyperparathyroidism is roughtly 80 % solitary adenomas, 12 % diffuse hyperplasia, 2 % multiple adenomas, and 1 % cancer. In patients with multiglandular parathyroid disease, imaging is not as reliable. In addition, size limitation of the abnormal gland can limit the detection by radionuclide scanning. SPECT (3 dimensional) imaging, as an adjunct to planar methods, can greatly increase the scan sensitivity and localization reliablity, especially in cases of small or parathymic adenomas. By using a gamma camera in nuclear medicine, the radiologist is able to determine if one of the four parathyroid glands is hyperfunctioning, if that is the cause of the hyperparathyroidism. Theoretically, the hyperfunctioning parathyroid gland will take up more of the Tc99m-sestamibi, and will show up 'brighter' than the other normal parathyroid glands on the gamma camera pictures, especially because of the internal biofeedback loop within the body with calcium inherently feeding back to calcium-receptors and inhibiting parathyroid hormone production within the normal parathyroid glands. Sometimes this determination must be made three or four hours later when activity taken up by the thyroid and normal parathyroid glands fade away; the abnormal parathyroid gland retains its activity, while the radiopharmaceutical is eluted out of the normal thyroid gland. However, in patients with nodular goiter or functional tumors of the thyroid gland, increased uptake of the sestamibi agent is possible and make parathyroid localization difficult or confusing.

By knowing which of the four parathyroid glands is hyperfunctioning, a surgeon is able to remove only the one parathyroid gland that is producing excessive amounts of parathyroid hormone and no longer under the biochemical control of the body, and leave the other 3 normal parathyroid glands in place. This operation is now termed a "minimally invasive parathyroidectomy", sometimes utilizing a radionuclear detection probe, and correlated with intra-operative parathyroid hormone level measurements. The remaining 3 glands are able to properly regulate serum calcium levels appropriately after the resolution of the hypercalcemia, as the calcium receptors lead to stimulation of parathyroid hormone secretion.

Retrieved from "http://en.wikipedia.org/wiki/Sestamibi_scan"  

Please take a look at parathyroid.com too.

[maria19609]

Thanks so much for all the information. You're very informative! I'll go to that site once again and try and make sense of everything (parathyroid.com) & Once I get my appt. with the Endo, I'll keep in touch. Again Thank You so Very Much.
Just one more ?. Is it possible to be hyper even though the pth 11 & calcium 9.6 with vit. D deficiency?

[stella5349]

Yes there is a primary and a secondary hyperpathryoid disease classification.

It is possible to have either a primary or secondary parathyroid disease along with either a primary or secondary hyper or hypo thyroid situation.