What's going on if i have low calcium but elevated pth levels?

Several things: Low vitamin d levels, or kidney failure would be among the more common causes of low calcium and high PTH levels.

Needs more work-up: Low blood calcium level with elevated PTH (parathyroid hormone) result from a variety of conditions, ranging from simple low calcium or vitamin d intake (rare in us) to poor absorption thereof from intestine caused by malfunction of liver, pancreas, or kidneys.

Deficiency : Primary hyperparathyroidism usually presents with hi calcium. Hi PTH & low calcium may be secondary to a vitamin d deficiency, maybe phosphorus retention. The answer to find is whether this could be chronic renal failure, malabsorption preventing absorption of vitamin d from gut, side effect of some drug, very poor diet, rare genetic d/o (children), etc. Please discuss with your doctor.

Calcium and PTH : If you have a low calcium (c) level and a high pth, you probably have secondary hyperparathyroidism caused by chronic kidney disease (ckd). You should see a nephrologist and have your renal function evaluated. It is likely that you have stage 3 or 4 ckd. You may need some medicines to lower your PTH level and increase your c. See a nephrologist as soon as possible for appropriate therapy.

Low calcium: PTH elevates in response to low calcium. It could also be elevated due to 25 OH vitamin D deficiency.