Ionized calcium too high?

[sophie50]

Dr. Lupo,  I have now had 5 tests this year.
Calcium 10.8

Ionized calcium  1.37 H  (1.17-1.32)
Calcium 10.2
PTH 17.7

Ionized Calcium 1.37 H
Calcium 10.2
PTH 22.4

Ionized Calcium  1.37 H
Calcium 9.9
PTH 25.4

Ionized Calcium 1.37 H
Calcium 10.3
PTH 25.4

My doctor is at a loss.  I am being told that the calcium level is not TOO high and we will just monitor it.  Thyroid levels are stable.  Vitamin D is low as usual.  I take 50,000iu but when I go to 2000iu daily, levels fall within two
weeks.  Bone and joint pain.  Negative sestamibi. Negative for FHH.  This has been going on for two years with calcium many times @10.8 to 11.4.  Three doctors (GP, Endo and Otolaryngologist) have all said it is not pHPT and we should just monitor??  Parathyroid.com says chronic high levels cause stroke etc.  Doctors are not interested in researching latter website.

AT WHAT IONIZED CALCIUM LEVEL SHOULD FURTHER IMMEDIATE TESTING BE DONE?  Since this has already been monitored for two years (with many visits, blood tests and constant complaints), HOW MUCH LONGER SHOULD I HAVE IT "MONITORED"?

Any help would be appreciated.

[sophie50]

I have now seen a new GP for another opinion.  I had another blood test.  This time the Calcium/PTH was sent out to a different  (supposedly more reliable?) lab for comparison.  The reference range for calcium was also different.

Calcium 10.4 HIGH (8.5-10)
PTH 8 LOW (15-65)

The calcium was AGAIN high. Does the PTH being that low rule out pHPT?  Now I am not sure what to think??  This was the first PTH below range. I am at the end of my rope. Do you have any suggestions?

[Mark Lupo, M.D.]

It's most likely primary hyperpara --- The PTH is lower than most cases, but in this setting that would be the most common diagnosis.  Consider consulting w/ parathyroid.com docs.