Last month I described some health difficulties that I had been experiencing for quite awhile. Lab tests that had been drawn earlier in the summer suggested that the problem might be secondary hyperparathyroidism and I also had been having a number of odd symptoms including calciphylaxis that can be associated with secondary hyperparathyroidism but is a more common in end stage renal disease (ESRD) particularly for patients on dialysis who were also receiving calcium supplements (and calciphylaxis is associated with eight times increased morbidity in ESRD). In the second post I reported that I was already feeling much better on the treatment plan that I had developed for myself.
I started taking 300-500 mg calcium per day based on the theory that the symptoms were related to calcium deficiency secondary hyperparathyroidism. I also increased my protein intake except for eliminating egg white and tree nuts from my diet – as a precaution in case I had developed autoimmune sensitivity to those protein sources which I had been eating more regularly than other foods during a time when I wasn’t eating enough overall. A steroid skin cream containing Triamcinolon 0.5% applied twice a day helped the calciphylaxis like skin sores heal. And I started taking 40 mg Benicar/olmesartan per day in an attempt to modify the low vitamin 25 D and vitamin 1, 25 D > 42 pg/mL. Levels of vitamin 1, 25 D above 42 pg/mL signals the bones to release calcium and phosphorus and can increase risks of osteoporosis and soft tissue calcification. [1, 2: MPKB- Science behind olmesartan (Benicar).]
- Secondary hyperparathyroidism, calcium deficiency and irritability,
- Elevated parathyroid hormone (PTH) and 1-25-D, calcium deficiency and calciphylaxis,
The 6/15/15 lab values:
- Parathyroid hormone level – PTH Intact – 154.1 pg/mL — normal range: [15.0-75.0]
- Calcium – 8.8 mg/dL — normal range: [8.4-10.2]
- Phosphorus was not ordered but would probably be good to check.
- Vitamin D, 25 – 10.9 ng/mL — normal is considered: [30.0-100.0]
- Vitamin D 1, 25 – 55 pg/mL — normal is considered: [18-72] (the active hormone D)
The 10/12/2015 lab values:
- Parathyroid hormone level — PTH Intact — 66.1 pg/mL — normal range: [15.0-75.0]
- Calcium — 9.3 mg/dL — normal range: [8.4-10.2]
- Serum Phosporus — 3.6 mg/dL — normal range: [2.5-4.5]
- Vitamin D, 25 — 18.4 ng/mL — normal range: [30.0-100.0]
- Vitamin D 1, 25 — 36 pg/mL — normal range: [18-72] (the active hormone D)
So I started taking calcium supplements and 40 mg of Benicar on September 23 and on October 12 my parathyroid hormone level is back within the normal range. My active 1, 25 D is below the osteoporosis inducing level of 42 pg/mL and my inactive vitamin 25 D level increased from 10.9 to 18.4 ng/mL — even though I am not taking vitamin D supplements but I do get more than fifteen minutes of sunshine most days of the week. My calcium level is still within the normal range but it went up from near the low end of the range to closer to the middle, from 8.8 to 9.3 mg/dL.
During the last couple days the calcium supplements have been causing me to have increased muscle cramps and irritable mood and I found that soaking in Epsom salt tub or footbath helped reduce the muscle cramps and bad mood. So the balance between magnesium and calcium intake is important and intestinal malabsorption of magnesium may be part of the underlying problem.
Overall I’m feeling much better than I was in early September before I started taking the calcium supplements. I had been having a racing heartbeat on very little exertion (like tachycardia) and for a long time I had been having an internal jittery-ness that felt like a bottled up pressure that needed a release valve or pinprick to pop the overfull bubble. The painful skin sores had been a fairly new and very unpleasant development. So yippee I have skin again! And I can walk downstairs without having to pause to let my heart rate slowdown.
I still have autoimmune thyroid antibodies but my thyroid hormone and thyroid stimulating hormone levels are within normal range — 10/12/2015 lab values:
- Serum Thyroglobulin AB — 41 IU/mL — normal range: [0-40]
- Serum Thyroid Peroxidase AB — 301 IU/mL — normal range: [0-34]
- T3 Free Serum — 4.09 pg/mL — normal range: [2.77-5.27]
- T4 Free Serum — 1.14 ng/dL — normal range: [0.65-1.86]
- Serum Thyroid Stimulating Hormone — 1.20 mIU/L — normal range: [0.46-4.68]
To prevent autoimmune hyperthyroid symptoms I have been avoiding foods containing gluten and iodine sources since receiving the diagnosis in 2013. The gluten protein molecule contains a section called gliadin that is chemically similar to the thyroid hormone. The chemical similarity between gliadin and the thyroid hormone may allow autoimmune thyroid antibodies to develop in susceptible individuals, so avoiding gluten in the diet may be helping reduce or prevent the production of the autoimmune thyroid antibodies.
–The bad news – my endocrinologist still wants me to take a vitamin D supplement for my low vitamin D. [previous post: Whether to be compliant or to be healthy seems like an easy question to answer,
/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./
Secondary hyperparathyroidism and calciphylaxis symptoms; an update with lab values by Jenny