Calcitriol and Calcium Supplements effect on Parathyroid Glands

[Maryfran33]

Three months ago I had surgery for a parathyroid adenoma.  The surgeon also removed my thyroid because he said it was small and friable; he left in 2 1/2 parathyroid glands.

I have been taking 2400 mg. calcium citrate daily as well as .25 mcg. Calcitriol 4 times per day.  I also take 100 mcg. Synthroid.

My test results for February 23 were as follows:  Serum Calcium:  8.3; Ionized Calcium:  1.05; Magnesium: 1.9; PTH: 14.6; T4: 1.2; TSH: 0.09.

My test resuslts for March 23 were as follows:  Serum Calcium: 10.1; Ionized Calcium: 1.27; Magnesium: 2.0; PTH: 2.5; T4: 1.2; TSH: 0.11.

Questions:  Could the Calcitriol and calcium supplements be suppressing the parathyroid glands?  

                   Do the PTH levels mean that the parathyroid glands are functioning on their own?

                   Is it normal to have a low TSH level since I do not have a thyroid?

                   Is it better to keep the calcium levels on the lower side of the range to minimize kidney damage?

                   How often should the calcium and thyroid levels be checked?

This has been very confusing, particularly so because of the unplanned thyroidectomy.  I believe that the surgeon had trouble finding the parathyroids.    I do not always get clear cut answers from the endocrinologist, and many times the physician's assistant acts as a go-between.  I would very much appreciate whatever clarification you can provide.              

[TamraW]

Hashimoto's is an auto-immune condition, not just a thyroid issue. Hashi can be brought on by environment, diet, stress... If you do have Hashi, then I recommend this book: www.thyroidbook.com for a better understanding of how Hashimoto's is an auto-immune disease, and the factors that can exacerbate the symptoms.

It is important to know what fried your thyroid. These antibodies are still in your body, though they may not have a thyroid to attack (BTW- many times we still have thryoid tissue in our bodies after surgery).

Your endo should be testing your FT3 levels.

:) Tamra

[Maryfran33]

Thanks again for your comments.

September, 2008:  T4 was 1.02 and TSH was 2.53
October, 2009:  T4 was 1.04 and TSH was 1.69
December, 2009:  T4 was 0.08 and TSH was 1.62  (had high blood pressure problems)

My thyroidectomy and partial parathyroidectomy was January 8, 2010.

February 23, 2010:  T4 was 1.2 and TSH was 0.09
March 23, 2010:  T4 was 1.2 and TSH was 0.11

I don't know that I've ever been tested for T3.
Are you suggesting that I also have the antibody test TGab and TPOab for Hashimotos even though I have had a thyroidectomy?

Mary

[TamraW]

My TSH and FT4 levels were fine the first two tests. Thyroid levels can fluctuate with Hashimoto's. Please post your current FT4, FT3 and TSH levels.

The only real proof of Hashi is a thyroid ultrasound and the TGab and TPOab antibody tests. Well, we've seen by opening up your neck that the thyroid was fried. There's evidence leading to a Hashi diagnosis. Now get those antibody tests for a solid confirmation.

I have Hashimoto's. My parathyroid levels are fine now. I didn't suggest calcium prior to surgery but the night after the surgery. That's the suggestion on www.parathyroid.com so that the good parathyroids can wake up from their sleep.

:) Tamra

[Maryfran33]

Thank you very much for your reply!

When I have an actual appointment with the endocrinologist, I will ask her about Cytomel.

So far, I have no symptoms of low thyroid hormone, except for my hair thinning a bit.

As far as I know, only the one parathyroid was bad.  I have been given somewhat evasive answers by the surgeon.  I was not told to take heavy calcium before surgery because my calcium levels were too high to begin with because of the parathyroid adenoma.

I have no idea why the thyroid was friable.  Never had any tests for Hashimotos.  Only thyroid tests over the years have been for T4 and TSH, which had always come back in the normal range.

What's your situation?

Mary

[TamraW]

Don't worry about the TSH. It is a pituitary hormone, not a thyroid hormone. I wish your doc would be testing and treating your FT3 levels. I take 10 mcg Cytomel (a T3 drug). Synthroid is a T4 drug and many docs mistakengly think we only need Synthroid because our bodies will naturally convert the T4 to much needed T3. That isn't always the case. FT3 levels must be monitored and, if necessary, treated with a T3 drug.

Do you have symptoms of low thyroid hormone, such as constipation, depression, fatigue, pain in feet/legs, brain fog, dry skin and eyes, hair falling out, thinning eyebrows?

As for parathyroids, I've read that 9.6 is right where it needs to be. I am wondering if those parathryoids are still trying to catch up after shutting down due to that adenoma. When an adenoma is spitting out too much pth, those other parathyroids will shut down. They need to be kick started to get going again. Why did he leave 2 1/2? Were two parathyroids bad? Did you take that heavy calcium the night after surgery to kick start those parathyroids? If you go to www.parathyroid.com, that doctor provides plenty of parathyroid information.

Why was this thyroid friable? Any antibody tests (TGab and TPOab) to see if Hashimoto's was to blame?

Below is a website where I found a great endo. You want an endo who specializes in thyroid/parathyroid, not diabetes. Call the nurse and ask the endo if this doctor treats the symptoms and the frees for thyroid. My endo is very knowledgeable about treating thyroid levels. He's also knowledgeable about parathyroid issues.

http://www.thyroid-info.com/topdrs/

Some docs check thyroid levels every eight weeks, but mine treats my thryoid levels every four. Once we get me stabilized, then maybe once or twice a year.

:) Tamra