Frustrated with possible hyperparathyroidism

[1280]

Dr. Lupo,
I am becoming frustrated.  I am a 26 year old male with a 6 year history of hypothyroidism. I am off my synthroid 0.075 mg/d and my thyroid function has been stable for 8 months (TSH, fT4, FT3 are in range).I also have crohn’s disease and have had a resection of my ileum (10 yrs ago) and a small section of my large intestine.My Crohn’s seems to be in remission.
I have had the following lab results:
Jan 4: Ionic Calcium of 1.38 mmol/L (normal upper range to 1.35 mmol/l)
Feb 5:
Serum calcium of 2.57 mmol/L (normal up to 2.55 mmol/L)
PTH = 3.3 pmol/L (normal range up to 6.4)
Phosphorous = 1.20 mmol/l (range=0.8-1.4)
Chloride = 107 mmol/l (range=98-106)
Mar 29:
Ser Cal: 2.54 mmol/L (normal up to 2.55)
Ionized cal:1.43 mmol/l (normal upt to 1.35)
PTH: 2.4 pmol/L (normal up to 6.4)
Mar 7:
Serum cal 2.49 mmol/L
Ionized cal 1.37 mmol/L
PTH 3.6 pmol/L
Mar 14:
Serum cal 2.62 mmol/L
Ionized cal 1.47 mmol/L
PTH 5.9 pmol/L
Mar 21
Serum cal 2.56 mmol/L
Ionized cal 1.42 mmol/L
PTH 5.8 pmol/L
Mar 28
Serum cal 2.54 mmol/L
Ionized cal 1.47 mmol/L
PTH 5.0 pmol/L
Apr 10
Serum cal 2.50 mmol/L
Ionized cal 1.43 mmol/L
PTH 3.6 pmol/L
24 hr Urine cal in Feb was normal
24 hr Urine calcium on Apr 10
8.1 mmol/day (normal range up to 7.5 mmol/day)

I seem to have varying symptoms from day to day including anxiety, fatigue, aching bones, nausea, and tiredness.  I have also had a Sestamibi scan that was negative.  Both of my parents have normal calcium levels.  I think this is Hyperparathyroidism.  The internist I saw recently seems to think my symptoms could not be caused by such a small increase in ionized calcium and the ENT surgeon I was referred to says he cannot do surgery with these borderline numbers until I see an endocrinologist and have an adenoma localized.  Can hyperparathyroidism be diagnosed solely on these test results?  If this is hyperparathyroidism I would prefer to just have the surgery and continue on with my life.  Is that the best course of action in this case?

[Mark Lupo, M.D.]

This looks like hyperparathyroidism, but no guarantee that it is the cause of the symptoms.  Localization is sometimes difficult, but the best localization is to find the right surgeon --- check out parathyroid.com for lots of information on this disease.