Hypercalcemia under or overactive (para)thyroid?

[CyclingGirl]

Hello there,

My gp started treating me for hypothyroidism in March for slightly sub-range TH level and very high calcium levels with 25 Levo. I was really exhausted, difficulty walking and getting out of breath, 38bpm HR, frequent nasty migraines, spells of sudden dizziness, weight gain, dry skin, brittle hair and nails, numb hand, etc. . Up until now I was an amateur cyclist racing in various short and ultra endurance races.

On 25 Levo spells of dizziness and migraines went away, but after 4-5 weeks exhaustion started coming back. And I keep gaining weight.

The dose was increased to 50 Levo 6 weeks ago, because my pTH? levels went up, and my symptoms got worse. I was told I was close to the top of normal range (0.8 away?) before I need to see a specialist. I had another spell of migraine and dizziness is back.

My latest test came back with elevated calcium levels and thyroid hormone level (assume pTH) and a new gp is referring me to a specialist.

I asked for the test results to be released to me after I joined this community and realised there are different thyroid hormones (free T3 and freeT4) they should be also checking.

But without knowing what hormones they were checking, does anyone have experience with hypercalcemia and thyroid disease? I’m really confused and thinking I may have hyperthyroidism rather than hypo and I may be mistreated?

My chest X-ray and kidney ultrasound came back completely clear.

Thank you for any advice!

And I’ll keep educating myself as it really seams it’s a tricky condition to diagnose and manage!

[SlowDragon Administrator]

High calcium needs investigation

parathyroid.com

You should have vitamin D, calcium and parathyroid hormone levels tested together

Have you vitamin D tested at all

Are you currently taking any vitamin supplements, if yes

What supplements exactly

Essential to test folate, ferritin and B12 levels too

[humanbean in reply to SlowDragon]

You should have vitamin D, calcium and parathyroid hormone levels tested together

And phosphate too.

According to this link :

labtestsonline.org.uk/tests...

Parathyroid hormone (PTH) is required for calcium and phosphate balance. It is part of a ‘feedback loop’ that includes calcium, PTH, vitamin D, phosphate and magnesium.

[SlowDragon Administrator]

The dose was increased to 50 Levo 6 weeks ago, because my TSH levels went up, and my symptoms got worse

Hardly surprising TSH increased on just 25mcg dose levothyroxine

25mcg dose is half the standard starter dose…..only suitable for elderly, or child

Even 50mcg levothyroxine is only STARTER dose

Thyroid levels should be retested 6-8 weeks after each dose increase

Likely to need further increases over coming months

Which brand of levothyroxine are you currently taking

Many people find different brands are not interchangeable

Always test thyroid levels early morning, ideally before 9am and last dose levothyroxine 24 hours before test

Approx how much do you weigh in kilo

pathlabs.rlbuht.nhs.uk/tft_...

Guiding Treatment with Thyroxine:

In the majority of patients 50-100 μg thyroxine can be used as the starting dose. Alterations in dose are achieved by using 25-50 μg increments and adequacy of the new dose can be confirmed by repeat measurement of TSH after 2-3 months.

The majority of patients will be clinically euthyroid with a ‘normal’ TSH and having thyroxine replacement in the range 75-150 μg/day (1.6ug/Kg on average).

The recommended approach is to titrate thyroxine therapy against the TSH concentration whilst assessing clinical well-being. The target is a serum TSH within the reference range.

……The primary target of thyroxine replacement therapy is to make the patient feel well and to achieve a serum TSH that is within the reference range. The corresponding FT4 will be within or slightly above its reference range.

The minimum period to achieve stable concentrations after a change in dose of thyroxine is two months and thyroid function tests should not normally be requested before this period has elapsed.

[CyclingGirl in reply to SlowDragon]

Thank you, there’s a lot to digest. I’ll consult the test results once I get my hand over them hopefully before the weekend and I’ll go through the details

[greygoose]

As far as I know, calcium levels are to do with the parathyroids. The parathyroids have nothing to do with the thyroid, they are separate entities. But they get their name due to their position in relation to the thyroid.

So, having high calcium does not mean you're hyper. Having 'sub-rang' thyroid hormone levels means you'r hypo. The two things are not connected.

[tattybogle]

pTH = Parathyroid Hormone ~ this is nothing to do with thyroid function/ or thyroid hormones , it comes from parathyroid glands (which are positioned very close to thyroid gland)... parathyroid hormone is related to calcium regulation, which is the job of the 4 tiny parathyroid glands.

Problems with high or low pTH & calcium levels are called hyperparathyroidism and hypoparathyroidism ,and have nothing to do with thyroid function or thyroid disease

The parathyroid glands are sometimes removed or damaged by accident when people have their thyroid surgically removed .

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

TSH = Thyroid Stimulating Hormone~ this is a signal from the pituitary gland to the thyroid gland asking it to make more (or less) thyroid hormone (T4/T3)

When the levels of T4/T3 are too low , the TSH level rises (hypothyroid)

when the levels of T4/T3 are too high , the TSH level falls (hyperthyroid)

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

your Levothyroxine dose would not be increased due to a high pTh result ... it would be increase due to high TSH result.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

if you have issues with pTH and calcium levels, this would be why they may refer you to endocrinology .. to see if there is a parathyroid problem.

Hypothyroidism does not usually need any endocrinology involvement. GP's just adjust dose of Levo.

[CyclingGirl in reply to tattybogle]

Thank you, such a great explanation!

[kellyjoan]

Be aware that high levels of calcium are present in certain malignancies