High calcium with low PTH

[Dawg7666]

Hi, my calcium has recently trended up from 10.8 to 11.9 to 11.8.  My ionized calcium was 6.5, my PTH read 9 and then 8 a month later.  I am a 57 year old male.  I have been taking levoxythyrine for years and my doc took me from 225 to 250 mcg about the same time that my calcium started to go up.  I have had some GI issues that my gastro doc believes was caused by diverticulosis, and have disappeared with change of diet and addressing the constipation that I was experiencing with daily ( 2x)   Of meta mucil and 1x of myralox.  I have no other blood levels that are out of norm, my vitamin d is 37, and I have been taking 2000iu for years.  My prostate is healthy, my colonoscopy is current 15 months ago.  The only symptom I have is inconsistent bowels in terms of the color and shape of my bowel movements and a small amount of blood, believed to be caused by my internal hemmeroids.  I actually feel better than I have ever felt.  My GP has ordered a chest x-ray and urinalysis to rule out possible lung or chest cavity malignancies or mylenoma.  If those come back negative, as I believes he suspects they will, he plans on referring me to an endocrinologist.  I just don’t see any references anywhere to conditions that exist when calcium is high and PTH is low.  Everything I have read about hypercalcemia talks about high calcium with high PTH or hypocalcemia with low calcium and low PTH.  Anybody have any experience or knowledge about conditions that might arise in a generally healthy person with high calcium and low PTH?  Thank you!

[Barb135]

Have you never been tested for Free T3? That's the hormone that's used almost every cell in your body, while Free T4 is considered a storage hormone and must be converted to Free T3 prior to use.

Looking at your Free T4 and TSH results it looks like you might not convert adequately. You should ask you doctor to test Free T3 every time you have Free T4 and TSH.

Even though you've been taking 2000 IU vitamin D, your level doesn't seem to be increasing adequately. You might want to increase your does until your level gets up to 50, then you could drop back to the 2000 IU to see if that will maintain.

[Dawg7666]

Thanks Barb135,

I appreciate you responding.  I have put my T4, free and TSH results from the last few years below.  During that time my levoxothyrine dosage has gradually increased from 200 - 225 - 250 mcg.  

I have been weening myself off the daily myralax, while changing my diet and increasing my fluid intake.  I have been taking 2000iu of vitamin D for years.

Date T4, Free (.8-1.8) | TSH (.4-4.0)
12/14 1.43                    |          2.6
5/16         1.61                    |          1.7
12/16 1.67                    |          2.6
7/17         1.60                    |          4.42
8/26/17 1.65                   |           5.18
9/25/17     1.61                    |           2.69

I appreciate you taking the time to review my information.

[Red_Star]

Hypercalcemia (high calcium) of malignancy virtually always shows low or undetectable levels of PTH. Rarely, low or undetectable levels of PTH with hypercalcaemia can be due to primary hyperparathyroidism with parathyroid adenomas.

One study concludes the diagnosis of primary hyperparathyroidism should be pursued despite suppressed or low-normal serum intact PTH levels after carefully excluding other causes of hypercalcemia. Study: "Very low or undetectable intact parathyroid hormone levels in patients with surgically verified parathyroid adenomas." PMID: 18284640.


Causes of hypercalcemia (from fpnotebook)...

Malignancy
See Hypercalcemia of Malignancy
Breast Cancer with bone metastases
Lung Cancer
Head and Neck squamous cell cancer
Renal Cell Cancer
Hematologic
- Multiple Myeloma
- Hodgkin's Lymphoma

Paget's Disease of Bone

Hyperparathyroidism
Primary Hyperparathyroidism (most common cause)
Multiple endocrine neoplasia (type 1 or 2A)
Familial Hypocalciuric Hypercalcemia
Lithium treatment
Secondary Hyperparathyroidism
- Vitamin D Deficiency
- Chronic Kidney Disease (Renal Osteodystrophy)

Medications:
Thiazide Diuretics
Lithium
Vitamin A toxicity
Vitamin D Toxicity (e.g. 25-Hydroxyvitamin D2)
Milk alkali syndrome
Theophylline

Endocrine:
Adrenal Insufficiency
Thyrotoxicosis (Hyperthyroidism)
Pheochromocytoma
Acromegaly

Other causes:
Familial hypocalciuric hypercalcemia
Prolonged immobilization
Granulomatous disease (Sarcoidosis, Tuberculosis)
Williams Syndrome
Jansen Disease (metaphyseal chondrodysplasia)

[Dawg7666]

Thanks Red_Star:  am I incorrect in that Hypercalcemia of malignancy generally presents in latter stage cancer patients?  I have no other abnormalities presenting or other symptoms aside from the high calcium and low PTH.  Thank you.

[Red_Star]

Yes I have read high calcium is in the late stages of cancer.  

[Barb135]

It's a normal reaction for PTH to be low if calcium is high, if one doesn't have hyperparathyroidism.  It's how the parathyroids attempt to control calcium levels in the blood.

"under normal conditions, a low serum calcium level will be associated with a high parathyroid hormone level; and a high calcium level will be associated a with low parathyroid hormone level. These are all appropriate ways in which a parathyroid gland will react to calcium which is circulating in the blood as the parathyroid glands attempt to regulate calcium in the narrow "normal" range."

You can read about the parathyroids at the following link:
http://www.parathyroid.com/diagnosis.htm

I'd also like to mention that your vitamin D, at 37 is not adequate, even though it's "in range".  Vitamin D needs to be at least 50 to be adequate.

You might also be able to help your constipation by eating more fiber, drinking more water and taking digestive enzymes and probiotics, rather than relying on the Metamucil and Miralax.  Metamucil isn't so bad for you, since it's actually a source of fiber, but Miralax isn't the greatest, even though it's recommended by doctors all the time.

I only mention these things because I've had enough stomach trouble to sink a battleship and all the Metamucil and Miralax in the world couldn't help it, because I had bacteria imbalance, which is where the probiotics came in.  I also had problems digesting foods, which is where the digestive enzymes come in.  None of my doctors picked this out, including my gastroenterologist... I stumbled on it by accident, through my research and eventually had to have a test that showed I had an overgrowth of a bacteria called H. Pylori.  You may not have that, but any bacteria imbalance in the gut can cause bowel issues.

And don't forget that constipation is a prime symptom of hypothyroidism, so if you continue to require laxatives, I'd suspect that your thyroid hormones are not adjusted properly.  If you'll post your actual thyroid hormone levels, that would be helpful and I can determine whether you're getting the proper testing/treatment with that, as well.  Many doctors only look at TSH when adjusting thyroid hormones and don't take symptoms into consideration.  Be sure to include reference ranges with any lab results posted as ranges vary lab to lab and have to come from your own report.

[Dawg7666]

thanks Barb135,  my response was posted as an answer to this thread

[Dawg7666]

thanks Barb135,  my response was posted as an answer to this thread