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Hyperparathyroidism?

For at least 10 years, I have been complaining to my doctors about an ache on the right side of my throat. It is more or less constant. None of them can ever find anything wrong (visual examinations only, no imaging tests). For most of those years I also had an undiagnosed adrenal tumor which caused Cushing's syndrome. This tumor was finally discovered about 2 years ago, and I have fully recovered from most of the symptoms I had experienced over the years. I am extremely tired all the time, and I have a terrible memory these days, and cannot focus for any length of time. I have not been able to work in over 6 years. I sleep 12-14 hours per day (8-10 hours at night and a nap in the mid morning and a nap in the afternoon). I have achy legs and often have cloudy urine. I asked my gyn to do a bone density scan because of the Cushing's and I have mild osteopenia. My endo tested my vit D levels and they are very low so I take 5000 iu of D3 daily. I am so tired of being tired. I am thinking of asking for a test for hyperparathyroidism. Do my symptoms correlate? What other tests should I ask for? Oh, I have had thyroiditis. I take 100 mcg of levothyroxine. I also take 40 mg cymbalta for fibromyalgia symptoms (upper back pain) I am 46 and female. I had a hysterectomy (uterus only) in 2012 due to fibroids. Also, my maternal grandfather died of pancreatic cancer, my mom died of hemolytic anemia (thymoma), my maternal cousin has PCOS. Is it just coincidence that we have so many endocrine tumors and diseases?
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Avatar universal
Urinary calcium and serum inorganic phosphate could also be measured. In hyperparathyroidism you may have eg. tiredness, cognitive impairment, abdominal and muscular pain. Some have symptoms in legs.
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Avatar universal
I have primary hyperparathyroidism, hypothyroidism and lots of other diseases. Possibly without any connection to hyperparathyroidism, I have unknown tumors in my lungs, minute cysts in my liver and pancreas. I have had an enlargened lymph node in my neck - it was then calcified. I have  had cysts in my thyroid gland, and they have shrunken to small ones. Also the thyroid gland itself has shrunken.

As to parathyroid glands, they are so small that they are seldom seen in ultrsound. If there is a large adenoma, then it can be seen. In a private cancer center I ordered a Sestamibi Technetium scan on my neck. It revealed possible hyperplasia in one of my parathyroids. Hyperplasia is much more difficult to be seen than an adenoma. It is also rarer. And also more difficult to be cured, because all (normally four) parathyroids ought to be examined to see whether there is hyperplasia and whether they should be taken off..

My total serum calcium is normal, but ionized Ca is often too high, sometimes high normal. Also PTH varies. I suggest ionized Ca to be measured for you, and, at the same time, parathyroid hormone (PTH). Vitamin D is also important.
I suggest to repeat the measurings after a month or more, preferly several times. That is because the values may be normal at some time and high at some other time.

See parathyroid.com.
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Avatar universal
additonal labs (from september), fyi:

Free T3  was 3.22 (ref 2.18-3.98)
Free T4 was 1.55 (ref .76-1.46) this is borderline high.

Cholesterol is up every visit-->I am a vegetarian who avoids refined sugars and rarely consume dairy or eggs. Current total is 247 but HDL is (and always has been) very high also.
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And lymphocytes were slightly low.
This lab work was not done while fasting.
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B12 result: 533 (range 254-1320)
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So the ultrasound shows a nodule on the right lobe. Doc wants to recheck in 6 months.
She said all of my labs were normal, and she is sending the full results in the mail.
With my history of endcorine tumors and family history, I am reluctant to just watch and wait on the nodule.
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Avatar universal
I forgot to ask her about the ferritin. I barely made it there I was so tired and out of it. I can definitely ask for the lab report. I'll call tomorrow and stop by when I go to the ultrasound, since it is next door. It is a good point that normal readings can be deceptive.Thanks!
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Avatar universal
Don't ever accept from a doctor that a test is okay because it is in the so-called "normal' range.  The ranges for Free T3 and Free T4 are way too broad, due to the erroneous method used to establish them.  Since Free T3 has been shown to correlate best with hypo symptoms, it is important to know the actual result.  Many members do not feel well until their Free T3 is in the upper part of its range and Free T4 around the middle of its range, at minimum.  Do you think you could call and get the actual test result and reference range for Free T3?  Did you doctor refuse testing for ferritin?
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Avatar universal
At my appointment today, the doc said my free T3 was tested in September and was normal. She ordered a thyroid ultrasound--I guess abnormality on parathyroids will show up on this?--for tomorrow and took blood to check for anemia and also for D, B12, and folate. I will have to keep pushing for other tests but it is a start.
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Avatar universal
Make sure the T3 test is for Free T3, not Total T3.
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Avatar universal
Wow, this is so interesting. I have heard of MEN1 & 2, but did not seem to correlate with my experience. MEN4, however, is a new one on me, and seems like a possibility. I forgot to add that I have "cycstic changes" to my lungs--the doctor calls it emphysema, but acknowledges that it is very unlikely that a nonsmoker of my age would have emphysema with no other risk factors. I am due for another lung scan soon. My lung function is fine at this time, it was an incidental diagnosis, but I see that MEN4 can be associated with lung tumors.
Off to doctor at 3 pm to ask for tests. Wish me luck :-)
Thanks for the info!!
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Avatar universal
Thank you, and yes, he usually sends me the actual lab report also, but this time either he didn't or I did not save it. I usually save all my test results.
I just made an appt with a different member of same general medicine practice and am going to ask for more tests, including B12, T3, Ferritin and PTH/calcium, thyroid antibodies, and thyroid and parathyroid scans.
Thanks! (Wish me luck getting all of this ordered!!)
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1756321 tn?1547095325
You might be interested in this info...

Multiple endocrine neoplasia type 1 (MEN1) and type 4 (MEN4). Mol Cell Endocrinol. 2014 Apr 5;386(1-2):2-15...

"Multiple endocrine neoplasia (MEN) is characterized by the occurrence of tumors involving two or more endocrine glands within a single patient. Four major forms of MEN, which are autosomal dominant disorders, are recognized and referred to as: MEN type 1 (MEN1), due to menin mutations; MEN2 (previously MEN2A) due to mutations of a tyrosine kinase receptor encoded by the rearranged during transfection (RET) protoncogene; MEN3 (previously MEN2B) due to RET mutations; and MEN4 due to cyclin-dependent kinase inhibitor (CDNK1B) mutations. Each MEN type is associated with the occurrence of specific tumors.

Thus, MEN1 is characterized by the occurrence of parathyroid, pancreatic islet and anterior pituitary tumors; MEN2 is characterized by the occurrence of medullary thyroid carcinoma (MTC) in association with phaeochromocytoma and parathyroid tumors; MEN3 is characterized by the occurrence of MTC and phaeochromocytoma in association with a marfanoid habitus, mucosal neuromas, medullated corneal fibers and intestinal autonomic ganglion dysfunction, leading to megacolon; and MEN4, which is also referred to as MENX, is characterized by the occurrence of parathyroid and anterior pituitary tumors in possible association with tumors of the adrenals, kidneys, and reproductive organs."
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Avatar universal
You should always make sure to get a copy of your lab test results.  By law doctors are required to give you a copy upon your request.  Then it is a good idea to write on the report how you were feeling at the time and what meds/supplements you were taking.  Those then become  very valuable for future reference.

There are a number of things that can cause/contribute to the type of tiredness you mentioned.  Among those are inadequate levels of Free T3 and Free T4 thyroid hormones, low B12 and low levels of ferritin (iron related).  Since you are taking a T4 med, and your Free T4 is likely in the top of its range, since you still are very tired it is possible that your body is not adequately converting the T4 to T3.  Scientific studies have shown that Free T3 correlated best with hypo symptoms, while Free T4 and TSH did not correlate at all.  So, it would be a good idea to go back and get tested for Free T3, along with Free T4.  I also suggest testing for Vitamin B12 and ferritin.  If your doctor resists, just insist on those and don't take no for an answer.  

As for the cloudy urine, there is no reason to suspect it as being related to deficiencies in any of the recommended tests.  I found this when I looked it up.  "When the urine does not have its characteristic clear appearance, it is often referred to as cloudy, turbid, or foamy urine. Cloudy or foamy urine may occur occasionally due to mild dehydration; when it occurs in the absence of symptoms and goes away rapidly, it is usually of little consequence. Certain conditions can cause excess protein or crystalline substances in the urine, causing it to persistently appear cloudy or foamy. Infections anywhere in the urinary tract can cause blood and pus to appear in the urine, giving it a cloudy appearance. Additionally, many of the numerous causes of blood in the urine can yield a cloudy or murky appearance to the urine due to the presence of blood. In women with vaginitis (such as yeast vaginitis), the vaginal discharge may sometimes contaminate the urine sample, making the urine appear cloudy."  So, you need to determine if that should be evaluated further with your doctor.  

When you have additional test results, please post them here, along with ranges, and we will be glad to help interpret and advise further.    
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Avatar universal
And he did not test for B12 or ferritin. Thanks!
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Avatar universal
My doc sent me my results but not the actual lab report so I don't have ranges.
He simply said my TSH was .549 and T4 was 1.55 and that my thyroid was in range. "No medication changes needed at this time."
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Avatar universal
Please post your thyroid related test results and reference ranges shown on the lab report.  If tested for B12 and ferritin, please post those as well.  
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