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Could this be a parathyroid problem?

My 14 year old son has a normal PTH:23, High normal calcium:10.5; and low VitD:22.  He has been suffering with muscle and bone pain, daily headaches, fatigue, a feeling of lump/tightness in throat, and chronic infections such as ear and sinus and virus.  Oddly, over the past 5 years, his PTH has been decreasing from a high of 53 to now 23.  Over the same time span his calcium hit a high of 10.7 and a low of 10.1. He has been on Vit D supplements for a year - 1000mg D3 - without any increase in his levels. This variability seems odd to me.  Does anyone have any insight?
3 Responses
Avatar universal
Your son's calcium levels are obviously too high.   It appears that the cause is being misdiagnosed.  From the link, note the following information that seems to fit your son's situation.  

"Here is the most important fact on this page: since vitamin D is required for humans to absorb calcium in their intestines, a low vitamin D cannot ever be the cause of high blood calcium. This fact is not debatable.  Thus, if you have a low vitamin D and your calcium is above 10.0, then the high calcium in your blood must have come from somewhere else other than your diet (it came from your bones). Thus, if you have a low vitamin D, and a calcium level above 10.1, then you are almost guaranteed to have primary hyperparathyroidism and need surgery to remove the parathyroid tumor. A low vitamin D cannot ever be the cause of high blood calcium. "

Also, "The most common mistake we see from family doctors and endocrinologists regarding the diagnosis of primary hyperparathyroidism is that the low vitamin D confuses them and they think the patient has SECONDARY hyperparathyroidism. In other words, they think the low vitamin D was the CAUSE of the high blood calcium because the low vitamin D caused the parathyroid glands to become over-active. They then think that they can fix the high calcium by giving you high doses of vitamin D.  We're here to tell you that there is no such thing as secondary hyperparathyroidism caused by low vitamin D that results in calcium levels above 10.1.  No Such Thing."

"The body also wants to shut down calcium absorption from your intestines. It does this by limiting the amount of Vitamin D in your body. Thus, if your body determines that your calcium is too high... it can decrease the amount of calcium that is absorbed from your intestines by decreasing the amount of Vitamin D available. If your Vitamin D levels are decreased, you can't absorb so much calcium from your diet. This is a protective measure."

https://www.parathyroid.com/low-vitamin-d.htm

1 Comments
This is very helpful, thank you.
1756321 tn?1547095325
Teenagers normally have calcium between 10 - 10.7. Vitamin D needs to be higher.

Vitamin D Council has listed the amount you need daily to achieve certain vitamin D levels.

20 ng/ml 1000 IU
30 ng/ml 2200 IU
40 ng/ml 3600 IU
50 ng/ml 5300 IU
60 ng/ml 7400 IU
70 ng/ml 10100 IU
4 Comments
In view of his symptoms, calcium levels, lack of response to Vitamin D supplements, and decreasing output of PTH, it seems to me more likely to be hyperparathyroidism.    
Hyperparathyroidism is too much PTH.
Note the following quote:  "Most doctors are not very good at diagnosing parathyroid problems and hyperparathyroidism. Normally, parathyroid disease is found because your doctor checked your blood for abnormalities and found the calcium level was too high. Typically, the doctor will repeat the calcium to see if it really is high, or if it was just a 'lab error'. If the calcium is high again, the doctor will order a parathyroid hormone level to be checked. If the parathyroid hormone comes back elevated...that's it... you almost certainly have parathyroid disease (hyperparathyroidism). If the PTH level is "normal"... that's it, you still almost certainly have hyperparathyroidism. High calcium and and PTH level that is not very low means it is extremely likely you have hyperparathyroidism. "

In addition, "The most common symptoms of hyperparathyroidism are chronic fatigue, body aches, difficulty sleeping, bone pain, memory loss, poor concentration, depression, and headaches."   The boy's symptoms were reported as "muscle and bone pain, daily headaches, fatigue, a feeling of lump/tightness in throat, and chronic infections such as ear and sinus and virus."   Some common symptoms.  

However, you are correct about calcium levels being somewhat higher with teenagers.   I had understood this was only with younger children.  Also Vitamin D deficiency has a couple of the following symptoms that could be related, but if the problem were low D, why was there no reaction to the daily supplements for a year?  

thinning or brittle bones, osteoporosis, or frequent bone fractures
muscle weakness, particularly if there is an unexplained change in muscle strength
changes in mood, with people who have low vitamin D experiencing anxiety or depression
chronic pain, as vitamin D plays a key role in supporting bone, muscle, and cell health
high or rising blood pressure
exhaustion, even with enough sleep
decreased endurance

So Vitamin D supplement could be increased in an attempt to bring up his level to at least 50 ng/mL; however, if there is hyperparathyroidism,  taking Vitamin D will not bring up his serum level and is also not recommended.  So before going further Suz1004 please post your son's actual Vitamin D levels.   Also I will follow up with some experts on hyperparathyroidism and see if I can find out about more about how it manifests in teenagers.  
1000 IU of vitamin D is a maintenance dose.  I had a look at the parathyroid website and found this...

"Teenagers with hyperparathyroidism typically have blood calcium levels between 10.9 and 12.3--it isn't subtle. For us adults over 35-40 years old, however, "frequent or persistent calcium levels above 10.1" means we are almost guaranteed to have a parathyroid tumor. As you will read below, a calcium level of 10.5 in an adult over 60 years old is more dangerous than a calcium level of 11.5 in a 20 year old.

One small teaching point here... the blue area starts around age 10 because hyperparathyroidism is so rare below age 10 that it essentially doesn't exist. Remember, people of any age above 10 can get a parathyroid tumor, but the peak incidence is between the ages of 50 and 80."
Avatar universal
Okay Red_Star, thanks for the input.
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