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Dr. Andrew Rynne

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Exp 50 years

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What causes flank pain inspite of having calcitriol for PHPT?

Answered by
Dr. Shehzad Topiwala


Practicing since :2001

Answered : 1663 Questions

Posted on Sat, 9 Aug 2014 in Thyroid Problem and Hormonal Problems
Question: I have been diagnosed by my endo with phpt. My serum calcium at 11.3, ionized at 5.8, pth normal now at 65 was 142 before starting calcitrol three times per week. I am 46 yrs old and classic of all symptoms, though I do not show osteoporosis on bone density I have bone pain and creek and pop up my every move. I am told kidney function is fine but just noted lab egfr at 53.3and phosphorus at 25. No kidney stones but do have flank pain. Also have hasimotos. Referred to surgeon who was not inclined to operate and says that surgery doesn't necessarily take a way symptoms of fatigue, myalgia, gerd, bone pain,constipation, lack of concentration. Should I get second opion and is there any reason to consider taking thyroid too? Sick and fired of being sick and tired
Answered by Dr. Shehzad Topiwala 2 hours later
Brief Answer:

Detailed Answer:
Sorry to hear about your symptoms.

1 Do you know if your thyroid antibodies like TPO (thyroid peroxidase and or anti thyroglobulin) have been ever tested?

If yes, would you be able to recall if they were positive?

If they are then you likely have permanent hypothyroidism ie an under active thyroid and for this only levo thyroxine alone has been recommended. Synthroid is one brand name medication for the generic levothyroxine

3 Do you recall your highest TSH value ever?

If it was abnormally high then a condition called Secondary hypothyroidism is extremely unlikely

4 Regarding PHPT, i have never heard of anyone being treated with calcitriol for PHPT.
I see your calcium is high but I would like to know the normal range for ionized calcium on your laboratory result. Also, the phosphorus at 25 is unusual. Is it a typo for 2.5?

5 I would like to know the blood test result for 25 hydroxy vitamin D

6 If the diagnosis of PHPT is made correctly, current recommendations favor surgery. Obviously, these are individualized decisions that are made after one on one discussion between the patient and the endocrinologist

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
Follow up: Dr. Shehzad Topiwala 10 hours later
Thank you for your reply. I don't know that I have ever been tested for TPO, but I have been tested for lupus and rheumatoid arthritis both prevalent in immediate family. Not however a-1 globulin was at high margin of normal.

His best TSH was 7 and previously regulated to 1.0 with 137mg of synthroid. The endocrinologist I am seeing as of march changed meds to cytomel twice daily at 50mg. Tsh registered at 2.6 and I feel best around one so he supplemented with 50mg of synthroid every other day. No new blood work yet.

I stand corrected phosphorus was 2.6. Alkaline phosphatase was 25 on a 53-125 range, yet albumin was normal at 4.6. Vita D Hydrox was 53.9 and said to be low thus the reason for adding calcitroil. Egfr =53.33

Answered by Dr. Shehzad Topiwala 4 hours later
Brief Answer:
Follow up

Detailed Answer:
If your case summary summary is accurate then i must say some of the treatments are not standard of care.

There are two types of blood tests for vitamin D.

One is the 25 hydroxy vitamin D and the other is 1,25 dihydroxy vitamin D. Calcitriol is considered as a treatment when the 1,25 dihydroxy vitamin D is low, especially with the calcium being low too. This typically occurs in certain types of kidney problems.

The test result for vitamin D you have shared does not specify which type of vitamin D was tested. Either way it does not appear low from my recollection of conventional units. The easiest way to resolve this is to look at the range of normal on the lab report.

Regardless, a fresh look at addressing your situation seems worthwhile.

Secondly as mentioned previously, levothyroxine alone suffices for the treatment of hypothyroidism. It is not difficult for an endocrinologist to regulate an individuals thyroid requirements with this medication alone
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

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