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What Does This Blood Report Indicate?

Posted on Tue, 16 Aug 2016

Question: What is considered to be very High PTH levels
My ESR is elevated - 35 (my age is 45)
PTH - 356.2
Ca - 8.2
Vit D - 25
From what I have read the PTH is way out of range, I seem to be Vit D insufficient but I can't see this raising the PTH this high. I have been dealing with a lot of symptoms for years, (Severe Headaches - I have never had all my life till 3-5 yrs ago, NO sex drive - Not unable works fin! Just no interest. Muscle spasms, severe bone aches, vision issues- have always had 20/20 or better, and numerous others) I am steering toward hyperparathyroidism, but the issue I have is the ca - level of 8.2. What I have been able to find that rules it out, but this also explains ALL my symptoms. I have been unable to find any PTH levels anywhere near mine (That didn't have a tumor). I have a appt. with Encro on Aug 4th, but I am afraid he is going to say same thing, that this is not what it is, but not give me any clue what it is. I have gone to my primary for years with these issues and he has found nothing. I just want to be myself again, I am now where near what I was even 5rs ago. I have no energy and can't get enough sleep, no matter how many hours I sleep.

Answered by Dr. Shehzad Topiwala (18 minutes later)

Brief Answer:
PTH

Detailed Answer:
Sorry to learn about your bothersome symptoms.

There are some uncommon disorders that can explain this. One such example is hyperphosphatemia ie high blood phosphorus levels which can drive up the PTH appreciably.

Other problems such as kidney disease with
High Serum Creatinine
and
Low serum 1,25 di hydroxy cholecalciferol levels

can also raise the PTH substantially.

Moreover, the calcium test you have undergone may not be 100% reliable. The best
test is a fasting ionized calcium level.

When I see someone like you in my practice, I typically order the following blood tests in addition to a detailed physical examination:

CBC (Complete Blood Count, also known as Hemogram; includes Hemoglobin, WBC and Platelet counts)
Electrolytes (Sodium and Potassium in particular)
HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c
Liver function tests (SGOT , SGPT, Albumin, Bilirubin, Alkaline Phosphatase)
Kidney function tests (BUN, Creatinine)
TSH (checks your thyroid)
Ionized Calcium
Phosphorus
Magnesium
Intact PTH

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Shehzad Topiwala (1 hour later)

WBC - 5.4
RBC - 4.6 (L)
HGB - 14.3
HCT - 41.5(L)
MCV - 90.2
MCH - 31.1(H)
MCHC - 34.5
RDW - 12.9
MPV - 8.4
PLT - 284
NE% - 60.2
LY% - 27.1
MO% - 9.9
EO% -2.5
BA% - .03
ESR - 35(H)
VIT D - 25(L)
NA - 135(L)
K - 4.2
CL - 101
CO2 - 26
BUN - 14
CREA - 1.01
Gluc - 90
CA - 8.2(L)
T. XXXXXXX - 0.5
T. Prot - 6.8
ALB -3.8
ALP -86
SGOT (AST) - 21
SGPT (ALT) - 30
Osmo -(CALC) - 270.1 (L)
eGFR - 84.57
RF Quantitative CMC - <15
PTH Intact - 356.2 (H)

Does anything stand out to you?

Answered by Dr. Shehzad Topiwala (8 hours later)

Brief Answer:
Follow up

Detailed Answer:
I have reviewed the lab results you provided.

Run these tests and see an endocrinologist in-person who will have the opportunity to examine you thoroughly.

Serum Osmolality by Direct method
Urine Osmolality
Urine sodium
Uric acid
Serum Cortisol at 8 am

HbA1c (Glycosylated Hemoglobin = your last 3 months' glucose average). Also known by other names such as GlycoHemoglobin or Glycated Hemoglobin or A1c

TSH (checks your thyroid)
Ionized Calcium
Phosphorus
Magnesium
Intact PTH

Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar