New here. Not sure if I have a problem yet, any advice?

Hi. I am a 53 year old woman and have been feeling unwell for a fair while. Fatigue, dizzy, tinitus, high blood pressure, finding everyday tasks exhausting, edema in my feet and others. I was diagnosed recently with autoimmune subclinical Hypothyroidism but the Endo is still investigating my symptoms and ordering tests. I am due to see him again in 10 days and just got my latest blood tests back. I have a few out of range results and wondered if I need to bring up any specific Hyperparathyroidism questions at my visit or if these results are not really related to the condition. I have googled some but find it a bit confusing due to calcium levels. The results that concern me are
Parathyroid hormone - 8.1 pmol/L (1.6-6.9) high
Phosphate - 0.71 mmol/L (0.80-1.50) low
25 hydroxy Vitamin D - 17 nmol/L severe deficiency
Calcium though is in range at 2.33 mmol/L (2.2-2.6)
Adjusted calcium 2.42 mmol/L (2.2 - 2.60)
Appart from Albumin (low), Globulin(high) and thyroids all other results were in range. Oh except low B12 and folate from previous tests.
So any thought please as to whether it may be parathyroid related or not and if there are things I should ask my Endo. Thanks in advance. Angie

Hello Angiema and welcome to our forum.

It is definitely worth asking about your raised PTH (Patathyroid Hormone).

Your PTH may simply be high as an attempt to increase your vitamin D production, so getting your Vitamin D level up could be the first step.

I suggest that you have a look at our useful website links page for a range of information on both Hyperparathyroidism (and Hypothyroidism).
In particular, this link on Normocalcemic Primary Hyperparathyroidism: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3127400/

There can be a fair amount of overlap between the symptoms of Hyperparathyroidism and Hypothyroidism, which can make diagnosis a bit of a challenge.

On the subject of Hypothyroidism, there is no such thing as 'subclinical Hypothyroidism'.  You either have it or you don't.
'Subclinical' is an invention by doctors who are only focussed on potentially misleading blood tests such as TSH, which does not necessarily correlate with Hypothyroid symptoms. TSH and Free T4 thyroid hormone levels are only part of the bigger thyroid physiology, including T4 to t3 conversion (which can be measured) and absorption of T3 at a cellular level (which cannot be measured).

Low Vitamin D, B12 and Iron are typical causes of poor T4 to T3 conversion.  T3 is the active thyroid hormone, so it is extremely important, but frequently ignored by doctors who are fixated on TSH as being the most meaningful level (which is isn't) ;-)
If you have had your Free T3 tested (the most important thyroid hormone), there is a good chance that it will be low (in-range, or 'normal' is not good enough) FT3 should, ideally, be between 50% and 100% of the upper reference range level.

Edwin (Admin)

Thank you for the links and for the information Edwin. From what you say I am guessing that the first step then will be Vit D supplements followed by further tests. Pathology ladies will not be happy, they can never get an arm vein and always have to get a senior to go into my hand.
Neither my GP or my Endo have ever mentioned or ordered tests for T3. Other than TSH and T4 all they have done is thyroid antibodies which were high. The Endo put me on 50mcg Levo because my TSH was 9.8 (0.47-4.5) and my T4 was bottom end of the range and I was symptomatic. My TSH is still over range at 5.8 after 14 weeks on the dose. I will ask about adding the T3 test next time.

Hello Angiema

Your TSH is still way to high, most feel better when its 1 or lower, as Edwin said a TSH of 9.8 is not subclinical its definitely hypothyroid !

All of your symptoms are likely due to the thyroid problem and hopefully when your levels are better some or all should resolve. You should be getting an increase in Levo dose at your next Endo visit, assuming he/she is on the ball reading thyroid results correctly, many are not !

You will need some more calcium and pth tests to see if they remain where they are or if calcium increases, most of us find they do go up and down over time but if there is a parathyroid problem calcium would normally stay high within the range or go over rather than dipping to the low end.

Hope that helps, do keep us posted

Nelly

Thank you Nelly and will do

Hi again. Just an update as promised. I saw the Endo today. I have been given an increase in Levothyroxine from 50mcg to 75mcg. I got a prescription for a loading dose of Vitamin D 30,000 iu once a week for 10 weeks to fix the deficiency (was supposed to be 4,000iu a day but pharmacy didn't have that strength).
I mentioned a small lump on my neck. It might just be a benign Lipodema since I have one on my arm already which was scanned recently. The Endo though said there was still a possibility of secondary Hyperparathyroidism based on my Labs so it wouldn't hurt to get an ultrasound of my neck anyway just to make sure. I feel very reassured that he is being thorough. Angie.

That's a reasonably positive outcome for now, but 75mcg Levothyroxine is probably not going to be sufficient.

I have an overactive parathyroid and the endo doctor said no surgery necessary until calcium levels hit 11 and above. Calcium last checkup was 10.   I'm very frightened about all this. Anyone from New Jersey with parathyroid I would like to hear from you. Thanks Louise

A decision will be based-on both Calcium (usually adjusted/corrected Calcium) plus PTH from the same blood draw.


I suggest that you have a look at our Useful Website Links page for a wide range of information on Hyperparathyroidism.

Edwin

Can PTH ever become lowered?...Mine was high in the hospital.

If high PTH is caused by Primary Hyperparathyroidism, then yes, by removal of the swollen Parathyroid gland(s).
High PTH with high Calcium suggests Primary Hyperparathyroidism and is probably accompanied by low Vitamin D.

PTH can also be high because of Chronic Kidney Disease (CKD) - Secondary Hyperparathyroidism - which may be treated with Cinacalcet, or surgery.