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    What causes bone pain, chest tightness, sore throat and ear pain?

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Posted on Mon, 30 May 2016 in Thyroid Problem and Hormonal Problems
Question: My parathyroid hormone levels have been up and down for the last several months. I have had a general feeling of malaise for at least a year, with a severe bout of preeclampsia last May that led to a premature delivery. The doctors believed the preeclampsia was precipitated by some other existing medical condition but they have not been able to confirm that or diagnose it although they have diagnosed me with vitamin D deficiency. My calcium levels have been normal and my vitamin D was normalized after a 10-day run of 50,000 unit doses of vitamin D although it has slipped a bit again so I am continuing to take supplements. I continue to have bone pain, a "foggy" or confused feeling, migraines, chest tightness, and a pretty constant feeling that I am on the verge of getting sick (sore throat, ear pain, slightly swollen glands), etc. I have also had a recent problem with ringing in my ears and what feels like muscle spasms in my rib area. In the early part of December my PTH level was 89. I was told to take a "superdose" of Vit D for 10 days and be retested as my vitamin D was down to 13. After that I was retested and vitamin D was well within normal range, calcium was in the mid 9-s and my PTH was up to 130. I was sent to an endocrinologist who said my calcium levels were normal but the high PTH may be an indication of a tumor. He retested, told me my PTH was down to 23, and my vitamin D was low so I should start taking supplements again (4,000-5,000 units per day). I was concerned so my family doctor just retested me about a month later and my PTH is up to 79. I know that is still within the normal range but should I be concerned about these large swings? Is that ever normal? Except for right before I delivered, my calcium has been consistently within normal ranges. Any advice would be greatly appreciated. Thank you.
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Answered by Dr. Binu Parameswaran Pillai 2 hours later
Brief Answer:
Likely secondary hyperparathyroidism

Detailed Answer:
Good day
Noted your concern. The high PTH associated with low Vitamin D is likely to be secondary hyperparathyroidism. when calcium or vitamin D levels go down, parathyroid glands work excessively and PTH rise above normal. this is called as secondary hyperparathyroidism. Once Calcium and Vitamin D normalise, it will take some more time for PTH to stabilise. I hope your kidney functions are good.
Regards.
Binu
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Follow up: Dr. Binu Parameswaran Pillai 3 hours later
My calcium was never low. Once my vitamin D normalized my PTH XXXXXXX to its highest level, 129. Is that still attributable to the vitamin D issue? Thank you.
doctor
Answered by Dr. Binu Parameswaran Pillai 45 hours later
Brief Answer:
SUGGESTIONS

Detailed Answer:
Sorry for the delay in reply. apologies. Usually PTH is a pulsatile hormone and levels can fluctuate with in normal range.
In addition to calcium and vitamin D, many other factors affect PTH levels. Urine calcium excretion, Phosphorus levels etc are some of them. We need to look at all those factors.
Another thing is PTH assay. make sure your lab is collecting and transporting PTH sample covered in ice.
To start everything new,,it is better to do a Vitamin D level, Serum calcium , Albumin and phosphorus.
Please remember that if PTH elevation was due to wither calcium or vitamin D deficiency, it can take several weeks to months for PTH to normalise even after Vitamin D and calcium is normalised. In your case it may be good to do a Fasting Phosphorus level and a 24 hour urine calcium and creatinine ratio
regards.
Binu


Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Binu Parameswaran Pillai

Endocrinologist

Practicing since :2003

Answered : 1418 Questions

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