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Parathyroid pth and calcium problem

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)
31 Responses
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Avatar universal
I had problems passing urine multiple times in last 2 years and we even did ultrasound to find if there was any stone but we found no stones and I still occasionally get problems passing urine like 1 time every 2 months but right now I don't have it so endo did not consider that as my symptom.
Helpful - 0
Avatar universal
No my diet was not high in calcium right foods in around last 2 years. In vegan diet I eliminated diary foods but I also made a mistake to not include any calcium supplements. That is also one explanation which PHPT patients don't have, another explanation is I don't have any symptoms other than muscle weakness and some osteopenia in dexa report. So PHPT patients are probably were eating calcium right foods but I was not even eating that in last 2 years.

My endo said that most of the parathyroid.com patients are americans and Indians living in India don't share the same phenomenon.
Helpful - 0
Avatar universal
I think you'll find this info to be of interest.  

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

Please take special notice of this.

"If your endocrinologist tells you that your calcium is high because your Vitamin D levels are low... and wants to give you Vitamin D to make your calcium go down... then you should print this page and take it to them. This is wrong."

Helpful - 0
1756321 tn?1547095325
My serum calcium fluctuation of 0.07 mmol/L converts to 0.28 mg/dL.

As you have also stated, normal serum calcium fluctuations in the study was 0.1 - 0.28 mg/dL and more than doubled with primary hyperparathyroidism to 0.07 - 0.73 mg/dL.

In my opinion, i don't think taking vitamin D supplements will cause serum calcium fluctuations. There may be a study to show otherwise however.  As you are a vegan, your diet is most likely full of calcium rich foods.

Top 10 foods highest in calcium:

#1: Dried herbs
#2: Cheese
#3: Sesame seeds
#4: Tofu
#5: Almonds
#6: Flax seeds
#7: Yoghurt, milk, and other dairy products
#8: Green leafy vegetables (turnip, mustard, dandelion greens, collards, kale)
#9: Brazil nuts
#10: Herring
Helpful - 0
Avatar universal
Okay, I got the original paper from Endocrine Practice Journal by James Norman.
On page 387, read the 3rd paragraph.

http://parathyroid.com/CA%20PTH%20VTD%20PHPT%20NORMOGRAMS%2010000%20PATIENTS.pdf

It says "Before the first calcium measurement over 10.2 mg/DL (before the development of hypercalcemic PHPT), patients showed little diffrences from once calcium measurement to another (mean variability 0.19 ± 0.09 mg/dL). The variability more than doubled to 0.4 ± 0.33 mg/DL in those same patients when PHPT was evident (P<.001)"

So that means calcium can fluctuate between 0.07 to .73 in PHPT patients but in
normal patients it fluctuates between 0.1 to 0.28, right ?

My calcium indeed had gone down from 10.02 to 10.48 and then to 9.97 and
then again to 10.33 which equals to  0.46 variability in first case and 0.51 variability
in next one and then down by .36 points in last report. So what if
the 4 small vitamin D i took are making this fluctuations ? Or my lack of dairy sources
in the diet(vegan) are making this - for example maybe whenever I eat calcium foods
the calcium goes down ?
Helpful - 0
1756321 tn?1547095325
I had my PTH and calcium measured 18 days apart. I had severe magnesium deficiency at the time causing hypoparathyroidism. Even so, PTH and calcium fluctuations were minimal.  

PTH fluctuation: 3 mmol/L
Serum calcium fluctuation: 0.07 mmol/L
Corrected calcium fluctuation: 0.01 mmol/L.

I also had vitamin D deficiency: 30 mmol/L (12 ng/mL). Magnesium is the most important co factor for vitamin D absorption.  Muscle twitching is common with electrolyte imbalances. Electrolytes include potassium, sodium, calcium, magnesium.  

Secondary hyperparathyroidism is typically due to chronic renal failure although vitamin D deficiency can also cause this.  Secondary hyperparathyroidism usually shows up as low or normal calcium and elevated PTH.
Helpful - 0
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