Your situation is quite a bit like mine. My vitamin D was on the low side (27-30) but now is about 50, after taking supplement. I have had PTH tested about 6-7 times since 1/2020, and its been elevated all the time. I think 174 (1/2022) is the highest yet, and its never been normal since 1/2020. My 2 year bone density will be in November. I do have for a many years ostopenia in one femur head. I suspect my PTH levels will never be normal, and wonder if its better to do surgery now or wait and hope it is never needed. I have had two ultrasounds to look for parathyroid glands and they could not be seen. Reluctant to do a nuclear (possibly more definitive) scan as I would have to stop Synthroid and I do not want to do that unless absolutely necessary. Good luck to you. I am female and 79 (ugh) and otherwise in excellent health. Would you mind telling your sex and age?