calcium level v. vitamin D

[diane363]

Previous Med. Lab. Tech.
White  Female  45 years old  5’5’’  220lb.

I went to my family doctor because of heart palpitations, accelerated hear rate, excessive sweating, tiredness, edginess, and an overall feeling of being “out of whack”.
Doctor ran the following tests:

EKG-normal- heart rate 97/min
ECHO- normal except for some palpitations and heart rate between 97-103/min
Thyroid ultra sound- revealed multiple nodules- iodine uptake scan appointment in September
Normal

T4 Free- 1.1 .70-1.48
TSH- 1.79 .35-4.94
Calcium- 10 8.9-10     (3 years ago Calcium was 10.3)
Vitamin D- 25.3 ng/ml     32-100

PTH- 48 10-65

Doctor prescribed Vitamin D supplements. to be taken once a week. My concern is the discrepancy between the below normal Vitamin D and the calcium level   My understanding is that the purpose of Vit. D is to help absorb calcium. If my calcium is at a high normal level, do I really need an increase in Vit. D? The follow up question is, with a low level of Vit. D how is my calcium so high? Where does the calcium come from if it is not being absorbed in the intestines? Do I want a calcium any higher?
I asked the doc. To run the PTH after getting the above results came back.  I was surprised that it was as high as it was considering my previous calcium level. What I don’t know is how much or how quickly calcium or PTH levels fluctuate from day to day. The PTH may not be a relevant result considering the fact that it was not done at the same time as the other lab. tests.
My final question is should I see an endocrinologist? Or am I making a mountain out of a molehill?

[estrelinha]

I think you should go to an endocrinologist, and repeat the analyses of PTH and Vitamin D-25 (active) and Vit-D-1-25 (inactive form).  You are right about Vit D,Vitamin D increases the amount of calcium in our body and usually higher calcium levels tend to have lower Vitamin D levels. Must look for your parathyroid.

[redheadaussie]

What is the dosage of the Vit D you take? Why once a week? Vit D is lost on a daily basis. One of the few vitamins our body doesn't store. Did they do a blood calcium test or a urine calcium test? Calcium in the blood is all well and good as it shows you have calcium, BUT if you have a high level of calcium in the urine that means your Vit D is not doing its job, and is sending it bye-bye.
  Yes, see an endocrinologist. Too many doctors have too little knowledge in this field.
I am having severe low calcium (rather than high) and low Vit D issues (even after taking supplements) so I know where your concerns come from!

[estrelinha]

The calcium level in urine is very important here and also the measure of phosphatemia and phosphaturia (in urine). Vit D must be activated to work (skin, liver  and kidney), so it's important to measure both forms of Vit D to see what is going on.  If you have bone decalcification, need to do X-ray. There are many possibilities, so test Ca levels (urine and serum, PO4, Alkaline phosphatase, and 25- (OH) D3 levels. As been said it is time to go to an ENDO.