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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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How can hyperparathyroidism be confirmed and treated if necessary?

Diagnosed with Hypothyroidism Nov 2009 at 54 years with TSH 11.98,FT4 0.9. Symptom leading to diagnosis was abnormal vaginal bleeding in menopause. Have multi-nodular goiter. Started on levothroxin 50mcg. Had heart palpitations, prescription changed to 25mcg and non-generic, synthroid. By Jan 2010 TSH 1.07,FT4 1.1. August 2010 recheck showed TSH 8.47. Prescription changed to synthroid 50 mcg. October 2010 recheck showed TSH 2.5. January 2011 felt my concentration impaired, also beginning in November 2010 started experiencing lower back pain when standing to dry hair in morning and when walking in mall, sitting down brings relief of pain. Also for over a year, my mouth/throat feels funny in lower wisdom teeth area, tongue feels swollen at times. Jan 2011 blood work shows TSH 4.2, FT4 1.2. Vitamin D insufficiency (29 ng/mL). Doctor prescribed Vitamin D 50000, take 1 per week for 8 weeks. Should I be concerned about fluctutation in TSH? Is my medication working and at right level? My calcium is 9.5. How would I know if I have hyperparathyroidism? How often should my TSH be checked?
Tue, 30 Apr 2019
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Endocrinologist 's  Response
Hello,

The fluctuations of TSH has been due to the low dose (35 mcg) of levothyroxine.
You should have taken 50 mcg.
You need to check TSH once in 6 months.
The vitamin D dose you are taking is too high.
I would suggest 1000 UI per day.
Hyperpaeathyroidism is ruled out by checking calcium and parathormone level.

Hope I have answered your query. Let me know if I can assist you further.

Regards,
Dr. Mirjeta Guni, Endocrinologist
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How can hyperparathyroidism be confirmed and treated if necessary?

Hello, The fluctuations of TSH has been due to the low dose (35 mcg) of levothyroxine. You should have taken 50 mcg. You need to check TSH once in 6 months. The vitamin D dose you are taking is too high. I would suggest 1000 UI per day. Hyperpaeathyroidism is ruled out by checking calcium and parathormone level. Hope I have answered your query. Let me know if I can assist you further. Regards, Dr. Mirjeta Guni, Endocrinologist