Parathyroid Disease

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mlin00@newsguy.com - 09 Dec 2005 17:42 GMT

My doctor said I had slightly elevated calcium levels in my blood. He
suggested it might mean medication to control parathyroid disease. A
repeat blood test 6 months later showed slightly elevated parathyroid
hormone.

I did some reading on the web, and it seems to me that the only way to
treat an enlarged and diseased parathyroid gland is surgery. What
should I ask the doctor to do to confirm a diagnosis of parathyroid
disease? Should it be an ultrasound? Would that be a definite test?

I don't want unnecessary surgery, but on the other hand, I don't want
to be inadequately treated for a disease that may account for my
sudden onset of high blood pressure, thinning hair, and loss of
energy. Can this condition be treated with medications? What
medications could lower harmful levels of calcium and parathyroid
hormone?

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Robert - 09 Dec 2005 19:44 GMT

> My doctor said I had slightly elevated calcium levels in my blood. He
> suggested it might mean medication to control parathyroid disease. A
[quoted text clipped - 5 lines]
> should I ask the doctor to do to confirm a diagnosis of parathyroid
> disease? Should it be an ultrasound? Would that be a definite test?

An elevated PTH in relation to calcium is primary hyperparathyroidism. Most
of the diagnostic workup is to rule out other causes of elevated calcium,
cancer, sarcoidosis etc.
Localizing procedures are then carried out nech exploration, selective vein
testing, etc.

> I don't want unnecessary surgery, but on the other hand, I don't want
> to be inadequately treated for a disease that may account for my
> sudden onset of high blood pressure, thinning hair, and loss of
> energy. Can this condition be treated with medications? What
> medications could lower harmful levels of calcium and parathyroid
> hormone?

I would suggest a consultation with an endocrinologist.

He is a link to treatment as well.

http://www.umm.edu/altmed/ConsConditions/HyperparathyroidismPrimarycc.html

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Howard McCollister - 09 Dec 2005 22:01 GMT

>> My doctor said I had slightly elevated calcium levels in my blood. He
>> suggested it might mean medication to control parathyroid disease. A
[quoted text clipped - 26 lines]
>
> http://www.umm.edu/altmed/ConsConditions/HyperparathyroidismPrimarycc.html

Surgery is very effective and clearly the preferred method. If the calcium
AND parathyroid hormone are elevated, not much else it can be other than
primary hyperparathyroidism. Most cases of primary hyperparathyroidism are
due to a benign tumor of one of the parathyroid glands. The two approaches
are either neck exploration, look at all 4 glands and remove the adenoma,
vs. a minimally invasive approach. In the latter case, the adenoma is
localized first, then removed. Selective sampling is rarely done anymore -
the localization is preferentially done using a sestamibi injection and then
intraoperatively scanning to localize the gland that has taken up the
isotope. A small incision is made right over the gland, the adenoma is
removed. Primary hyperparathyroid problem solved. If all goes according to
plan.

HMc

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Mary - 09 Dec 2005 23:10 GMT

[...]

> Surgery is very effective and clearly the preferred method. If the calcium
> AND parathyroid hormone are elevated, not much else it can be other than
[quoted text clipped - 10 lines]
>
> HMc

Thanks. I would prefer surgery rather than taking medication for the
rest of my life.

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O'Hush - 10 Dec 2005 02:37 GMT

> Surgery is very effective and clearly the preferred method. If the calcium
> AND parathyroid hormone are elevated, not much else it can be other than
[quoted text clipped - 8 lines]
> removed. Primary hyperparathyroid problem solved. If all goes according to
> plan.

...which IIRC they try to ensure by drawing a PTH level a few minutes
after excision of the adenoma, before they sew you up.

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Robert - 10 Dec 2005 19:55 GMT

"Howard McCollister" <nospam@nospam.net> wrote in message

> Surgery is very effective and clearly the preferred method. If the calcium
> AND parathyroid hormone are elevated, not much else it can be other than
> primary hyperparathyroidism.

That only establishes that the PTH is inapproriately high. Although rare,
ectopic production of PTH by other sources is also possible.

Most cases of primary hyperparathyroidism are

> due to a benign tumor of one of the parathyroid glands. The two approaches
> are either neck exploration, look at all 4 glands and remove the adenoma,
[quoted text clipped - 4 lines]
> isotope. A small incision is made right over the gland, the adenoma is
> removed.

Some centers do an intraoperative PTH testing to ensure removal was
adequate. Here is one reference to the use of SVS.

1: ANZ J Surg. 2004 Sep;74(9):732-40. Related Articles, Books, LinkOut

Re-operation for hyperparathyroidism.

Liew V, Gough IR, Nolan G, Fryar B.

Division of Endocrine Surgery, Royal Brisbane Hospital, Australia.

INTRODUCTION: Re-operation for hyperparathyroidism (HPT) represents a
challenge for experienced endocrine surgeons. The present study reviews the
technical and pathological factors for failure of initial surgery and
identifies strategies to approach re-operative parathyroidectomy. METHODS:
Clinical details, operation notes, pathology, localization studies and
complications for re-operative cases performed by three surgeons were
reviewed. RESULTS: Over a 10-year period there were 40 re-operative cases
with a 98% success rate. There were 31 patients with primary HPT, 21 with
persistent primary (PP) and 10 with recurrent primary (RP). Multigland
disease (MGD) was present in 19 of the 31 (61%) primary HPT cases. The
culprit gland was ectopic in 14 cases, at a normal location in 10 and there
was regrowth at previously excised sites or remnant disease in 10. There
were nine patients with secondary HPT, four with persistent secondary (PS)
and five with recurrent secondary (RS). The culprit gland was ectopic in
five, at a normal location in four and regrowth at a previously excised site
in two. Pre-operative investigations were employed in all cases and the most
helpful were sestamibi scan (S) and selective venous sampling (SVS) for
parathyroid hormone (PTH) concentration. True positive localizations for S
was in 20 of 34 cases (59%), SVS in seven of nine (78%), computed tomography
(CT) in seven of 17 (41%) and ultrasound scan (USS) in 10 of 28 (36%).
CONCLUSIONS: Re-operative parathyroidectomy can be performed by experienced
surgeons with a very high success rate and minimal complications.

PMID: 15379798 [PubMed - indexed for MEDLINE]

Primary hyperparathyroid problem solved. If all goes according to

> plan.
>
> HMc

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Mary Lincoln - 09 Dec 2005 22:38 GMT

>I would suggest a consultation with an endocrinologist.
>
>He is a link to treatment as well.
>
>http://www.umm.edu/altmed/ConsConditions/HyperparathyroidismPrimarycc.html

Thanks, Robert, for the good information. I want to know my options
when I next see the doctor.

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