labs, again

so some of you remember that the last time I went to the surgeon, they adjusted my vits because my PTH was low, 8.4, and my D3 was high, 117, according to them.  so they had me discontinue the D3 and lower my calcuim.  So I just got back my labs and calcuim is down a little, 9.2 instead of 10.  D3 has dropped from 117 to 57.2 which is lower than I want.  PTH is still low, was 8.4, now 13.7 so it is better but still low.  Any ideas?  I have already started back on the 50,000u D3 at least once a wee****il my appt next week.

 I'll defer to Gina 

But I'm overdue for my vits labs.  Calcium is something I'm NOT good at taking, unless I have the Bariatric Chews.  I need to get some of them again.

I don't think it's actually bad to have your PTH be low. It's when it's high you have to worry. Some medical groups get hyper focused on keeping you within the lab ranges but some of those ranges are arbitrary and ever changing.

If I were you, I'd do D3 at half the dose you took to get you to 117. That should put you right in the middle of where you want to be.

Normally, lower PTH is better, but if your lab's range is 12 - 65, I understand why they're looking real hard at the relationships between your calcium, D3 and very low PTH. Perhaps they are trying to rule out a parathyroid malfunction or tumor. Might be worth asking about.

Calcium in the blood can be normal 9.2 and still be coming from your bones. A much higher PTH shows that you're losing bone calcium to keep soft organs going (like your heart) but yours doesn't seem to be terribly high even though you dropped your calcium and D3. Also know that PTH can lag behind your calcium and D3 status.

Lower D3 doesn't help your body absorb the calcium your take orally at all.

I would increase my calcium citrate and D3 again--perhaps step it back by half as Marie suggests. 117 is not toxic, or all that high, for D3. A level of around 80-90 is optimum.

Did you get a vitamin A lab done?

--gina

My group doesn't normally do A.  I have had it done a yr ago and it was right in the middle 42 (19-83).  I started some A then but stopped it when all this started. 

My big labs will be before my Nov appt.

They were freaked out that my D3 was high side of normal and had me cut it in half.  I was taking the 50,000u week.  Now at 20,000 per week .  Get labs re-drawn at end of month.

What problems does a high D3 give you?

They thought that was what was driving my PTH down but obviously not.  I think the current knowledge is that it is really hard to get toxic on D3.

high vitamin D can cause kidney stones and liver problems.  Not sure what else.

I had a vitamin D level greater than 150, they couldnt measure it and out of the blue - I had 4 obstructing kidney stones and was rushed into surgery.  Never had them before.

Your PTH level is very complicated.  When my Endocrinologist does, it gets ploted on a graph and it is plotted with calcium.  It is affected by both calcium and vitamin D.

Your high vitamin definitely does lower a PTH level but it takes time for it to go up. 

You said your calcium is down a little,  = it is down alot - Normal ranges are usually 8.8-10.0 or 9.0 - 10.2 but we want our level to be around 9.2 - 9,4 so you are just where you want to be.  Calcium is a tough thing to read since it can go 2 ways.  For many people a high calcium level  means they arent taking enough and it is high because it is leaking into there bones - causing a high PTH.

In your case, which isnt the norm for WLS patients, the calcium is high because you were taking too much causing the PTH to drop -along with the calcium being high, so was the vitamin D.  the strange part is that both your calcium and D levels dropped considerably but the PTH, only went up a little which is odd.

I have to say, I had vitamin D of greater than 150 - calcium of 9.8 and a PTH of 14.  My Endocrinologist though my calcium and PTH were fine but that the D was way too high so I stopped the D for 2 weeks, dropped to 112 (approx) and then went back on 2 times per week instead of 3 times per week and stayed at 112 so I cut to once per week and my D went to 57, all of a sudden my PTH went up to 118.  So, I am not sure why your PTH is staying so low but I wouldnt worry about it because that is a good thing.  It is at the low end of normal and that is what you want.  You dont want it high but low is great.  YOu went up 5 points