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Thyroid Diseases

Issues Pertaining To Various Urine And Blood Tests

03/10/2008

Question:

I began feeling run down about 10 months ago. Four months ago, I had increased arrhythmias, incredible fatigue, weight loss, nausea, insomnia and anxiety. At the onset of those symptoms, my serum calcium levels had gone up. I am a 34-year-old female with a 14-year history of calcium kidney stones. I have passed at least 20, and a CT scan has shown at least 9 more dispersed through both kidneys. Out of numerous blood and urine tests, the following results are the only ones out of normal range.

Serum Calcium: (normal up to 10.2) October high normal November 10.4 December 10.3 January 10.5 February 10.3

PTH: (normal 15-65) January 36.8

TSH Normal

My physician just called today and said my thyroid test came back positive for antibodies and indicates I may develop Hashimoto`s.

Can you offer any insight on these results? Would it be advisable to see an endocrinologist as a follow up.

Answer:

I think seeing an endocrinologist is a good idea. Excess parathyroid hormone (PTH) is the most common cause of an elevated calcium. Your PTH level makes it unlikely that this is the cause in your case, though it doesn't absolutely rule it out. If it can be determined that your calcium level is really significantly elevated and your PTH remains below normal, you should be checked for other possible causes of an elevated calcium. Almost half of the calcium in your blood is bound to albumin, so you need a serum albumin level to correctly interpret these calcium levels - it's possible that you're just a little dehydrated. A free ionized calcium level would help sort things out too. A 24 hour urine calcium would help determine whether or not these minimally elevated calcium levels are related to your kidney stones. These serum calcium levels are really not very high, and I think it is unlikely that they are the cause of all of your symptoms. The positive antibodies don't mean much if your thyroid blood tests are normal - they just mean that you should be checked periodically for thyroid disease.

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Response by:

Thomas A Murphy, MD, FACP, FACE Thomas A Murphy, MD, FACP, FACE
Associate Professor of Medicine
School of Medicine
Case Western Reserve University