Thanks for your reply!! To answer your questions (I hope I catch them all):
--My original high PTH that I just discovered was in 2022, but the one my PCP ran (that came back at 143.3) was just last week.

--I misspoke. My endocrinologist treats primary hyperparathyroidism (I left out the para) in my original post. I am going to see if I can edit. However, she treats thyroid issues, diabetes, insulin resistance, PCOS, etc.

--Yes, I am looking into Parathyroid now. I have had multiple full work-ups for thyroid over multiple years. I do have multiple thyroid nodules, but they are just being monitored every 6-12 months.

--My A1c is 6.0. It had been around 5.6 for almost a year. It was up to 6.4 in May 2022 when I had gastric bypass surgery. I got it down to 5.2 and had lost 90 lbs. Both started creeping back up a few months after my symptoms started and I am back up 55 lbs and my A1c is now back to 6.0. But the thirst and urination didn't get better despite if A1c was high or low. I was tested for Sjogrens, but despite my ANA being over 5,000, my specific titers for everything are always negative (tested twice).

I self-referred to Internal because at the time (and really still), we didn't know what is going on with me. I am currently under the care of cardiology (high bp and tachycardia), Rheumatology (positive ANA evaluation), endocrinology, psychiatry, neurology, and gynecology (being tested for hormone levels despite having had a hysterectomy with ovary removal 15 years ago).

My psychiatrist is the first one that kept saying it was something systemic and no one was considering everything. I mentioned to him today about the elevated PTH and he lit up. Said that fit almost all the boxes. He also said my friend is correct that if they aren't measuring ionic calcium then it might be missed that my calcium was high. So I will almost definitely be looking into a second opinion. Just not sure where.

My current symptoms/issues are:
--confusion
--brain fog
--headaches
--severe fatigue
--nausea at times
--sudden, unexplained weight gain
--I cracked 3 ribs coughing so I suspect bone issues
--constant aches and pains
--excessive thirst and urination
--increasing depression (but depression for me is not new)
--stable/medicated high bp and tachycardia
--dry, brittle skin
--slow healing