<s>[INST] daughter aged 16 presenting with severe and disabling back pain.  Had this for 3 weeks with constant pain but regular severe shooting pains.  Also pains in arms.  Losing a lot of hair during bath time and brushing.  Had a parathyroidectomy at the age of 11 with 4 parathyroids being removed one of which had an adenoma and 3 enlarded.  Had 5 parathyroids so one was left. Symptoms very similar to when this first occured but has had a calcium and pth blood test both of which are normal.  What could be causing such pains in her spine, lower and upper back. [/INST] Dear caring father Diffuse spinal pain may be due to vitamin D deficiency and low calcium levels. Since she has shooting pains in both lower limbs nerve compression can also be there. Parathyroid gland secretes hormone calcitonin which maintain bone density. Since your gland was removed it leads to low calcitonin level and hence low bone density. I would advise radiograph of dorsal umber spine anteroposterior and lateral views to check bony status. DEXA scan of bone is also advised to check bone density. Serum level of calcium, phosphorus and alkaline phosphatase should also be checked. Get all this tests done and visit endocrinologist nearby you. Also, ultrasound of neck to check thyroid status is advised. </s>