Hyperparathyroidism and HypoT

[sophie50]

I have positive TPO and TGab.  I take Synthroid 62.5 and Cytomel 5mcg daily.  My latest TSH was 0.02 but my FT4 fell to .84 (.58-1.64) and my FT3 is 3.5 (2.3-4.2).  I still feel SO tired and my moods are awful.  My Endo has already tweaked my Synthroid down due to the low TSH even though I am taking Cytomel (which I THOUGHT?? negated the TSH reading).  My PTH is normal at 27 but my serum calcium has been in the 10-10.2 range and my ionized calcium came back high at 1.35 (1.17-1.32).  My Vitamin D is also low between 20-35.  I do not take any Calcium supplements. I am really suffering from hip and thigh bone/muscle pain and feel old before my time.    Any idea what could be causing this?  Thank you.

[sophie50]

I will work on that.  It is VERY difficult to ask for tests when the Endo is adamant that there is no parathyroid disease.  I also have bone pain, muscle pain, weakness, anxiety, lack of concentration, irritability, wake up at night....just feel lousy!  I don't want to leave this Endo as he was the one that started me on HypoT treatment because he found positive TPO and TGab.  I really want to develop a relationship with ONE doctor!  My previous GP put me on antidepressants and said nothing else was wrong!  Maybe I will ask my new GP (who referred me to this Endo) about the Dexa Scan.  I had a drug store wrist test which showed osteopenia but I don't know how reliable they are.  Years ago I had a Dexa Scan which was normal but I cannot get hold of the records and, at that time, I was not knowledgeable to obtain copies of everything as I do now.

Thank you for your support!  Sophie

[Mark Lupo, M.D.]

At this point - just watching the calcium.  Vitamin D may help the bone pain, but could increase the calcium -- this is a tough place as the diagnosis is not clear.

[sophie50]

I had the Serum Calcium repeated.  It came back higher at 10.3.  This is the cut off for normal.  My doc says he will not even consider hyperparathyroidism because the PTH and serum calcium are normal.  All other tests were normal. He also said ionized calcium is unreliable.

He lowered the Synthroid.  I guess I have hit a roadblock unless the calcium goes higher.  Is there anything I can watch for other than this bone pain I have now to allow further investigation? Thank you.

[Mark Lupo, M.D.]

This looks like hyperparathyroidism - would consider repeating the PTH/Calcium levels to confirm as a PTH of 27 is tough to interpret as it is a little lower than typically seen with "inappropriately normal" PTH.  A low 25-OH-Vit D is seen in primary hyperparathyroidism and often leads to diagnostic confusion.  

A low TSH is still important - even on T3 treatment - either the T4 or the T3 dose needs to be lowered given a TSH this suppressed.

[sophie50]

I AM A PEST AND I KNOW IT!

I will see my Endo tomorrow and I hope he doesn't make light of my symptoms!  I have 11 of the 16 symptoms of hyperparathyroidism.  Oh after all these years, I hope and pray to get some answers!

I really would appreciate your input on this, Dr. Lupo

[sophie50]

I was given Vitamin D 50,000IU to take once a week in the hopes of raising the Vitamin D.  I have not taken it because I do not want to raise the calcium level any higher.  Will the Vitamin D supplement raise the calcium level? Does a high calcium level cause bone and/or muscle pain?  What would possibly cause high ionized calcium with normal PTH but low Vitamin D?  Something is just not adding up.  PLEASE would you let me know if I should pursue any of this?  THANK YOU!