Elevated Ionized Calcium

[ah3904]

I am a 23 year old healthy female.  Although I have all the symptoms of Hyperparathyroid.  To the extent that I just started Lamictal for my depression. I have HTN, heart palpitations, fatigue, constipated, excessive thirst it is ridiculous, frequent urination.  I usually generally just "don't feel good". My ionized calcium was tested and was in the "normal range" However it is borderline high.  It was 1.32 mmol/L.  Could I have the symptoms of hypercalcemia with that level?

[Mark Lupo, M.D.]

Thyroid testing appears normal.

The PTH is high, but the regular Ca is normal at 9.2 -- making the diagnosis more complicated.  The high normal ionized calcium is suggestive of early primary hyperparathyroidism, but otherwise the consideration must be secondary -- in either case the 25-OH-vitamin D will often be low, so this is not conclusive.

Would retest the ionized Ca, regular Ca and PTH (and possibly 25 and 1,25 vit D levels) in a few weeks, but would not postpone the cardiac testing as the levels are not consistent with a definite or severe hyperpara.  The small thyroid cysts are not likely clinically significant at this point.

[stella5349]

I think until Dr Lupo responds I would like to add:

I think in your situation with some levels being normal and some not your doctor may suggest a Sestamibi scan on the parathyroids.

It is so tough to really know when the calcium test comes out like yours is.

[ah3904]

If my PTH is 81 then is my diagnosis going to be Hyperparathyroid?  We just don't know yet if it is primary or secondary?  Can I still have symptoms with an ionized calcium of 1.32?
Dr.Lupo- Thank you for your response it was very helpful.

[ah3904]

Dr. Lupo,  I just called my MD for the rest of my labs and found out that my
PTH = 81 pg/ml
Calcium = 9.2
With all these labs is this Primary or Secondary Hyperparathyroidism?
With the PTH of 81 I assume that I do have Hyperparathyroidism and am so excited because I have been sick for so long...I thought I was a hypochondriac. Do you think this is just a tumor and once the parathyroid is removed my symptoms will be resolved? I am scheduled for a stress test and echo d/t palpitations and HTN, Do you think I still need them if the symptoms are due to hyperparathyroidism?
Please respond as soon as possible.  I am almost jumping out of my seat that I finally figured out what is  wrong with me!!!  I am actually a nurse so I have been trying to diagnose myself for a long but never thought of this.  I was thinking a thyroid disorder.  I actually have several tiny cysts on both lobes of thyroid.  The largest measuring 4mm is this significant?
Thank you in advance for offering your expertise to me and responding to this forum.

[ah3904]

I would like to add my other labs if they make any difference
Thyroid Peroxidase <10
Antithyroglobulin Ab <20
TSH 0.71
T4 7.6