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And now, another complication--

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Unread 01-10-2013, 08:13 AM   #1
glenntaj
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Default And now, another complication--

Those of you who follow my ongoing issues (I flatter myself, don't I) besides neuropathy may recall the thyroid nodule scare of 2011 and the hemoglobin A1c 5.7 level (first time I was ever in the "impaired tolerance" range) annoyance of May 2012.

Well, just got the most recent results back, and after losing 10 pounds, revamping my diet, putting on lots of walking miles, etc., hemoglobin A1c is back down to 5.5. Other labs are pretty good--EXCEPT calcium. Given that I've always had high normal levels there, we decided to test for ionized calcium (a more accurate measure of active, non-albumin bound calcium) and parathyroid hormone levels. The ionized calcium levels are a bit high--1.37 on the 1.05-1.34 scale--and my parathyroid hormone is also somewhat high at 83 (with upper limit 65--and for most people it shouldn't be higher than 35-40 with normal/high calcium levels).

This means I very probably have a growing parathyroid adenoma. Given that my mother had one removed 12 years ago, I wouldn't be surprised. Not an emergency situation, as only about .015% of these are malignant, and even those are indolent, but rising calcium levels have all sorts of nasty results down the line (bone loss being only the most obvious), so we'll need to do something about this--likely finding the offending parathyroid gland(s) and removing it (them).

I'm going for semi-annual thyroid ultrasound tomorrow, and I'm going to try to get them to change the filters to look for parathyroid enlargements, though ultrasound is often not sensitive enough to find those, and I may have to have a 4D CT or radioactive sestimibi scan to find those, especially if this is in the early stages. Not an emergency, but could be explanatory of my musculoskeletal aches and pains over the last year (and even of the reflux I had about 10 months ago). I've already contacted my people at Cornell Weill about a surgical consult with their endocrine surgery department (they know me well in that medical system). I will report, of course
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Unread 01-10-2013, 08:58 AM   #2
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Oh, my, that is something, Glenn!

Do you take Vit D? I'd ask the doctor if you should not take it or reduce dosing etc.

PTH can be elevated in people with low D. And the parathyroid issues ARE confusing! It is good you have good doctors.

I know you are thorough, too, Glenn. But here is a link for others to read, and if you haven't yet, it may help:

http://www.parathyroid.com/low-vitamin-d.htm

Please keep all of us in the loop!
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Unread 01-10-2013, 10:20 AM   #3
glenntaj
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Default Yes, thanks--

--I'm quite familiar with that site.

My Vitamin D levels--at least the D-25 levels--are right at the low end of normal (30.3, with the low end of the reference range 30). I'm waiting for results of the D-1_25 OH levels, which should be higher. This is consistent, as the site says, with higher calcium levels signalling the body's intestines to absorb less vitamin D in trying to keep the calcium levels from going too high. From a causal perspective, consistent with parathyroid adenoma. (Admittedly, there are many doctors who don't understand the point the site's authors are trying to make.)

Last edited by glenntaj; 01-11-2013 at 06:13 AM.
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Unread 01-10-2013, 11:32 AM   #4
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good luck Glenn. i hope you get to the bottom of this quickly.
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Unread 01-10-2013, 12:03 PM   #5
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Glenn-

Hope everything ok. Thank you for your post. I learn something new every day from the sharing of information from this wonderful forum! I too have very low D levels (below 15) without supplementation. Kaiser has routinely given me the 50,000 unit route and finally I have just gone to taking 10,000 to 15,000 units daily to keep my d levels up around 60. Just checked online and found my calcium level at 9.8 . I have not had any of the more specific tests you mentioned. Thanks MrsD for posting the link to the website. Very informative! One question-can hyperparathyroidism have an effect on nerves, specifically causing neuropathy? And from the website I gathered there really were not too many reasons why one has low d levels-first being low diet/no sun (neither in my case-outdoors way too much with horse farm) or hyperparathyroidism. Gives me cause to wonder...................
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Unread 01-10-2013, 01:51 PM   #6
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Not the D specifically I don't think....it is the abnormal calcium levels that cause paresthesias which are very similar to PN symptoms. The difference is that paresthesias, are temporary and when the electrolyte balance is fixed, should go away.
Our sensory nerves are for sending warning signals. These can be external in the environment, or internal metabolic derangements. Or a combination of both. If you remove the trigger, the signal reverts to normal. That is what a paresthesia is.

PN is actual nerve damage, that does not go away as a rule.
Sometimes healing can happen if encouraged, but most PNers don't know that and don't look for that, and only live on symptom suppressing drugs.
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Unread 01-10-2013, 02:41 PM   #7
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Glenn--I wish you the best always-- and I just hope they get down to it quickly for you!!
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Unread 01-16-2013, 05:35 AM   #8
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Lightbulb new diabetic diagnostic criteria:

Bumping this up, Glenn. I found two articles that are very
interesting about that A1C.

New thoughts are emerging about identifying diabetes today in the older population. With the baby boomers flooding our age group now, doctors are looking at new criteria in diagnosing type II diabetes in older patients.

1) http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3401566/

2)http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2551641/

As you can see in these two papers, fasting glucose, and GTT (2 hr probably) are being dropped in favor of A1C.

They are suggesting for older people that the cut off be 6.5.

I am printing these out for my doctor. The main reason I believe is that keeping blood sugar reading too low in the elderly is dangerous. The Accord study showed that the aggressive arm was not safe. Low blood sugars are showing high risk for Alzheimer's disease as well. So medicating or over medicating elderly patients may lead to more LOWs and hence affect brain functions.

I think you and I are in this boat. I am older than you, but have similar A1C readings presently. So at this time don't panic yet about your reading. It may just be a part of getting older.
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Unread 01-16-2013, 07:18 AM   #9
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Default Quite possibly--

--although I question whether over 50 years years of age blanketly qualifies as elderly.

I had always though that the A1c was probably a better measure of overall glycemic control anyway, notwithstanding that there are some people with relatively "normal" A1c levels that show hyperglycemic spikes and hypoglycemic crashes on extended glucose tolerance testing. These people usually, of course, have some degree of pre-diabetic metabolic syndrome/insulin resistance anyway (which testing insulin levels during the GTT often reveals), so they would need to be monitored closely in any case.

My own totally unscientific observations have been that A1c levels do tend to trend upward with age, even among my wife's running cohort. As my experience seems to be showing, this can be combated, but it gets tougher.
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Unread 01-16-2013, 08:17 AM   #10
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LOL I didn't like being "elderly" either when I got my RX for my GI problem gets flagged in the pharmacy as 'unsafe' for the
"elderly"...

At 50 some meds including things like Benadryl even get flagged for anticholinergic side effects that are more serious in older patients. sigh.

If you are below 60...you are technically "middle aged" still.

I am over 60 and I can tell you it is not too much fun!
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