Aa
Normal ca and vit d, high pth?
Dear Dr. Lupo,
I am a 26 year old female with no underlying health problems. My endo ran additional labs upon seeing I had a 1,25 dihydroxyvitamin d lab value of 89 approx one month ago, which my obgyn ordered for some reason when I asked her to check my vitamin d level. Lab results as follows
Calcium. 9.3 (also 9.3 in April 2011)
Pth, intact 87
Ionized ca. 1.23
24 hr urine ca level of 203
1,25 dihydroxyvitamin d...89
25vitamin d.....40 (22 in April 2011)
Phosphorus 2.9
Alkaline phosphatase...49
Tested negative for celiacs
My doctor said we will.continue to run labs and monitor it. He said it could be from previously low vitamin d levels. In your opinion, is previous vitamin d insufficiency more likely than primary hyperparathyroidism? What should be my next step?
Also, my tsh has decreased over the years ( I have it checked often due to family history of hypothyroidism and other autoimmune disorders). I have numerous hypothyroid symptoms but tested negative for thyroid antibodies. It seems like my tsh should be higher since my thyroid hormone levels are on the low end. My endo says he doesn't think there is anything wrong with my thyroid. What is your opinion?
Tsh 1.01
Free t4. .9
Free t3. 2.9
Thanks so so much!!
I am a 26 year old female with no underlying health problems. My endo ran additional labs upon seeing I had a 1,25 dihydroxyvitamin d lab value of 89 approx one month ago, which my obgyn ordered for some reason when I asked her to check my vitamin d level. Lab results as follows
Calcium. 9.3 (also 9.3 in April 2011)
Pth, intact 87
Ionized ca. 1.23
24 hr urine ca level of 203
1,25 dihydroxyvitamin d...89
25vitamin d.....40 (22 in April 2011)
Phosphorus 2.9
Alkaline phosphatase...49
Tested negative for celiacs
My doctor said we will.continue to run labs and monitor it. He said it could be from previously low vitamin d levels. In your opinion, is previous vitamin d insufficiency more likely than primary hyperparathyroidism? What should be my next step?
Also, my tsh has decreased over the years ( I have it checked often due to family history of hypothyroidism and other autoimmune disorders). I have numerous hypothyroid symptoms but tested negative for thyroid antibodies. It seems like my tsh should be higher since my thyroid hormone levels are on the low end. My endo says he doesn't think there is anything wrong with my thyroid. What is your opinion?
Tsh 1.01
Free t4. .9
Free t3. 2.9
Thanks so so much!!
One of the rules of primary hyperparathyroidism - "All patients with parathyroid disease have calcium levels and PTH levels that go up and down. Fluctuating levels of calcium are typical of parathyroid disease." As your calcium levels are stable, this is a good indication that you have secondary hyperparathyroidism.
From Mayo Clinic - Hyperparathyroidism causes:
"Primary hyperparathyroidism:
Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands:
A noncancerous growth (adenoma) on a gland is the most common cause.
Enlargement (hyperplasia) of two or more parathyroid glands accounts for most other cases.
A cancerous (malignant) tumor is a rare cause of primary hyperparathyroidism.
Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.
Secondary hyperparathyroidism:
Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. Therefore, your parathyroid glands overwork to compensate for the loss of calcium.
Factors that may contribute to secondary hyperparathyroidism include:
Severe calcium deficiency. Your body may not get enough calcium from your diet, often because your digestive system doesn't absorb the calcium you consume.
Severe vitamin D deficiency. Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps your digestive system absorb calcium from your food. Your body produces vitamin D when your skin is exposed to sunlight, and you consume some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.
Chronic kidney failure. Your kidneys convert vitamin D into a form that your body can use. If your kidneys function poorly, useable vitamin D may decline and calcium levels drop. Chronic kidney failure is the most common cause of secondary hyperparathyroidism."
From Mayo Clinic - Hyperparathyroidism causes:
"Primary hyperparathyroidism:
Primary hyperparathyroidism occurs because of some problem with one or more of the four parathyroid glands:
A noncancerous growth (adenoma) on a gland is the most common cause.
Enlargement (hyperplasia) of two or more parathyroid glands accounts for most other cases.
A cancerous (malignant) tumor is a rare cause of primary hyperparathyroidism.
Primary hyperparathyroidism usually occurs randomly, but some people inherit a gene that causes the disorder.
Secondary hyperparathyroidism:
Secondary hyperparathyroidism is the result of another condition that lowers calcium levels. Therefore, your parathyroid glands overwork to compensate for the loss of calcium.
Factors that may contribute to secondary hyperparathyroidism include:
Severe calcium deficiency. Your body may not get enough calcium from your diet, often because your digestive system doesn't absorb the calcium you consume.
Severe vitamin D deficiency. Vitamin D helps maintain appropriate levels of calcium in the blood, and it helps your digestive system absorb calcium from your food. Your body produces vitamin D when your skin is exposed to sunlight, and you consume some vitamin D in food. If you don't get enough vitamin D, then calcium levels may drop.
Chronic kidney failure. Your kidneys convert vitamin D into a form that your body can use. If your kidneys function poorly, useable vitamin D may decline and calcium levels drop. Chronic kidney failure is the most common cause of secondary hyperparathyroidism."
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Dr Lupo does not monitor this forum. In order to reach him, you will need to post on the expert forum. They only take so many questions per day and the excess gets dumped into this forum. We are all fellow patients, who have struggled with thyroid issues, just like you. We have some very knowledgeable members who would be glad to help if you like.
Reference ranges vary lab to lab, so we will need to know the ranges for all the tests you had done, as noted on your own lab report. Ranges are often listed in parenthesis beside the result. It's best to post them with the parameter, result, then range, like this:
Free T4 0.9 (x.x - x.x)
Free T3 2.9 (x.x - x.x)
That gives us what we need to know all right together.
All of that said, your vitamin D level still appears to be very low, even though it might be within the reference range, based on ranges we often see. Same is true for your Free T3 and Free T4.
It's very possible to have hypo symptoms, when actual hormone levels are low in the ranges.
Reference ranges vary lab to lab, so we will need to know the ranges for all the tests you had done, as noted on your own lab report. Ranges are often listed in parenthesis beside the result. It's best to post them with the parameter, result, then range, like this:
Free T4 0.9 (x.x - x.x)
Free T3 2.9 (x.x - x.x)
That gives us what we need to know all right together.
All of that said, your vitamin D level still appears to be very low, even though it might be within the reference range, based on ranges we often see. Same is true for your Free T3 and Free T4.
It's very possible to have hypo symptoms, when actual hormone levels are low in the ranges.
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