Parathyroid pth and calcium problem

[jayhealth]

Hello I have added my details below, can tell me if this is primary hyperparathyroid

Age - 23, male
Computer programmer - 8-10 hrs/day, don't go out in the sun

Past history
Following a low carb vegan diet 2-3 years (no dairy sources in the diet)
irritable bowel syndrome
Seizure around age 9-10

Symptoms
obvious - muscle weakness, osteopenia
subtle/occasional - memory problems, general weakness, anxiety, problems passing urine(no urine problems currently)

1st blood test (from Lab company A)

Calcium 11 mg/dl (8 - 10.5)  
Potassium  5 nmol/L  (3.5-5.5)
Serum iron 101.0 ugm/dl (59-158)
Total iron binding capacity 303 ugm/dl         (274-385)
Vitamin D 25 Hydroxy    3.42 ng/ml  (> 30 ng/ml)
Alkaline Phosphatase   353 U/L   (108-306)

Next day (From lab company A)
Calcium ionized 4.8 mgm/dl  (4.0 - 4.8 mgm/dl)
serum magnesium 1.8 (1.70 - 2.70)

I think after 1st blood test I took 2 small vitamin D supplements
which had 200 IU units in each and calcium citrate of 1000 mg.
I took it even before I got the lab results.

I had an 4-5 month old liver function test report which had
Alkaline phosphate 136 units/l (39-117)

2nd Blood test the very next day (From lab company A which outsourced my blood to company B)

PTH, intact   150 (10-65)  pg/ml
Calcium  12 (8.5 - 10.3)  mg/dl

Endo doctor said Lab A and B might be wrong, so let's check it again after 1 week.

3rd Blood test (From lab company C) after 1 week

Calcium, Serum  10.02 mg/DL  (8.10 - 10.40)
Calcium, ionized  1.26 nmol/L (1.16 - 1.32)
PTH, intact     103.80 pg/DL (15.00 - 68.00)

After this test I think I ate some dairy products like milk, eggs etc

4th Blood test (From Lab company C) after 2 weeks

PTh     61.20  pg/ml   (15-68)
Calcium, Serum      10.48   mg/DL (8.10 - 10.40)
Calcium, ionized    1.28   nmol/  (1.16 - 1.32)
Alkaline Phosphate   119.00 U/L  (30 - 120)
Phosphorus           5.00 mg/DL  (2.70 - 4.50)

Sodium 140 meg/L (137-150)
Potassium, serum 4.30 meq/l(3.50-5.30)
Chloride, serum 103 meq/l  (99 - 111)

5th blood test today  (From Lab company C)

Vitamin D, 25 hydroxy   28.80 nmol/L  (> 75 nmol/L)
converts to 11.53 ng/ml (>30 ng/ml)

Phosphorus, serum   4.66 mg/DL (2.70 - 4.50)
Potassium, serum   4.30 meq/l   (3.50- 5.30)
Magnesium serum   2.00 mg/dl  (1.80 - 2.60)

Other tests:

Calcium, 24 hours urine 85.50 (100-300) mg/24 hrs
total volume   4500   (800-1800)  ml/day

Sestamibi scan  = negative

Complete Haemogram

Haemoglobin   13.5   gm%   (13 - 17)
Total leucocyte count  5800  /cumm (4000- 11000)

Different Leucocyte count

POlymorphs  63 %  (40 -80)
LYMPHOCYTES   31 %  (20-40)
EOSINOPHILS     05 %  (1-6)
MONOCYTES   01  %  (2-16)
BASOPHILS      00  %  (1-2)
RBC   4.19  million/cumm   (4.50 -5.50)
platelet count   193000 /cumm  (150000 - 450000)
pcv     39.1 % (40-50)
mcv     93.4 femto litres  (83-101)
mch    32.2 pico grams   (27-32)
MCHC    34.5  G/DL (31.5 - 34.5)
ESR (We stergren)     05   mm/1 hr (5-30)

Peripheral Smear

RBC series        RBCs are normocytic normochromic
WBC series    TLC, DLC Within normals limits NO immature cells seen
PLatelets               Platelets are adequate
Haemoparasites                  No haemoparasites seen
Opinion                  Peripheral blood picture is unremarkable

Liver function test:

Total protein 7.34 g/dl (ref range 6.0 - 8.4)
albumin 4.67 g/dl (ref range 3.5 - 5.5)
globulin 2.67 (1.20 -1.60)
a/g ratio 1.75 (ref range 1.20-1.60)
total bilirubun   0.53  mg/dl  (0.10 - 1.20)
conjugated bilirubin  0.27  mg/dl (0 - 0.70)
unconjugated bilirubin  0.27  mg/dl (0 - 0.70)
sgot (ast)   17 u/L   (5-34)
alk phosphatas  119 U/L   (53-128)
gamma gt  18    u/L  (12-64)

Lipid profile

Cholestrol     136  mg/dl  (ref range 140 -220)
TRIGLYCERILE   70 MG/DL  (20 -150)
HDL - CHOLESTROL   39  mg/dl  (30 - 65)
LDL CHOLESTROL  85   mg/dl  (0-130)

(calculated parameter)

VLDL CHOLESTEROL   14  mg/dl  (ref range 5 -40)
LDL / HDL RATIO   2.18              (0 - 3.55)
CHOL/ HDL RATIO  3.49            (0 - 4.97)

Biochemistry

Blood sugar fasting   91  mg/dl  (ref range 70 -110)
urine sugar fasting    N.R

Blood sugar PP   95 mg/dl (ref range 80 -140)
urine sugar PP   N.R

Blood urea   17 mg/dl   (17 -55)
serum creatinine   0.65   mg/dl  (0.30  -1.30)
uric acid     4.73 mg/dl   (3.50 - 7.20)

[Red_Star]

Vitamin D uses magnesium to convert to active vitamin D. If you are not eating enough magnesium in the diet, you may develop "side effects" of vitamin D supplementation that are actually symptoms of magnesium deficiency.  There are many possible magnesium deficiency symptoms but they include constipation, headache, heart rhythm problems, anxiety, panic attacks, acid reflux/heartburn.

[jayhealth]

I've recently started eating complex cabs(starch) to increase some weight as I've low weight 59.8 kg, 173 cm. Can eating white rice cause headaches ? I've read somewhere that it contains Monosodium glutamate and can trigger headaches ? Or was the headache due to the vitamin d pill I took ?

[jayhealth]

And also I felt a little bit flank pain(pain in the right side of the stomach), so I drink full bottle of water and I'm now okay. Water is THE solution to all the symptoms lol

[jayhealth]

btw my blood pressure is normal but i get high heart beats and too much anxiety/panicky

[jayhealth]

Got new reports

20th oct

calcium serum 10.49 mg/dl (8.10 - 10.40)
alkaline phosphate 106 u/L  (30 - 120)

21st oct (I drank alot of water the night before this test, because I had rapid heart beats and felt alot of anxiety/panic. The heart beat was so fast that I was thinking of going to the hospital but I thought drinking water and moving a little bit might be okay; so maybe calcium is low the next day for this reason ? I'm not sure)

Calcium serum 9.90 mg/dl (2.40 - 4.40)
phosphorus     4.70 mg/dl  (2.40 - 4.40)

22nd oct

calcium serum   10.20  mg/dl    (8.10 - 10.40)

Developed some new symptoms

I stopped eating oats, bran as morning breakfast some days back.

On 19th oct I ate 2000 units of vitamin D in tablet form.

On 20th oct - I ate white rice and chickpea and some other stuff.
On 21st oct - I ate white rice and chickpea again at lunch.

On 21st oct I got constipation. Very strong headache in backside of the head(when I shake or move my head it pains very had) so I had to eat combiflam and headache was gone after couple of hours. I had similar headache 2-3 months back and I know it is very bad.I also had some abdominal discomfort. I'm not sure if it was heartburn/GERD/indigestion. But i felt worse.

on 22nd oct - still suffering constipation but feeling okay. I was also feeling some weird thing in the eye. It was not dry eyes like people get from using computers. For 2-3 seconds I was not seeing things clearly and it felt like I was about to fall. I immediately drank 1 big bottle of water and felt okay. Maybe its anxiety or I get too much panicky. I am also being told to get holter monitoring done. I'm feeling like that headache is coming back again

[Red_Star]

I meant hyperparathyroidism may cause no symptoms to severe symptoms, not hyperthyroidism if anyone reads what i wrote above. :) Your diet isn't that high in calcium as many of the foods on the list contain on small amounts of calcium.

I did miss your phosphate results in all that info. :)  In PHPT, serum phosphate levels are abnormally low however this is only in 50% of cases. Despite higher than normal labs fluctuations, secondary hyperparathyroidism due to vitamin D deficiency (a cause of high phosphate levels) is the most likely diagnosis.  

Just to add, there are conflicting studies on high amounts of folic acid causing cancer. More clinical trials need to be done.