Graves Disease - A Patient's Guide

My new mini-book is now available on Amazon and Kindle in paperback and ebook forms.

The book is written to help explain in simple terms what Graves disease is and how it can be diagnosed and managed.

Management is split into the short-term and also covers the definitive treatments of radio-active iodine and thyroidectomy surgery which are sometimes required.

http://amzn.to/1NTJb4n

www.thyroidsurgeon.org.uk Thyroidsurgeon.org.uk

www.bucksendocrine.com bucksendocrine

Parathyroid Glands - A Patient's Guide

New mini-book on Parathyroid glands explaining what they do, how they go wrong etc now available on Amazon.

http://www.amazon.co.uk/Parathyroid-Glands-Andrew-McLaren-FRCS/dp/1499205880/ref=sr_1_3?ie=UTF8&qid=1398335780&sr=8-3&keywords=parathyroid+glands#_


The book covers how to diagnose parathyroid disease and the various treatment options.

Kindle version also available.

www.bucksendocrine.com


www.thyroidsurgeon.org.uk

Parathyroid glands. A patients guide

I have written a mini book on the parathyroid glands.  What they are, how they work, how they go wrong and how they need fixing when they do!

Available on Amazon for kindle.

http://www.amazon.co.uk/Parathyroid-Glands-A-patients-guide-ebook/dp/B00JNTIURY/ref=sr_1_14?ie=UTF8&qid=1397592815&sr=8-14&keywords=Parathyroid
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Parathyroid Disease - Symptoms and Reality

Parathyroid disease - Symptoms and Reality

Many of the symptoms of parathyroid disease are non-specific, vague and difficult to pin down.

I have written before on the common symptoms patients describe and for clarity these are listed:

tiredness
lethargy
lack of 'get up and go'

muzzy head
difficulty concentrating

muscle aches and pains

bone pain - typically in the middle of bones away from joints
joint pains

abdominal cramps / discomfort

constipation

urinary frequency
nocturia - passing urine at night

thirst
dry mouth
irritating cough


The symptoms are various manifestations of the calcium levels being raised.

Symptoms are NOT caused by high PTH.

So it follows that a patient with a normal calcium level cannot have symptoms due to the calcium level being high and cannot have symptoms from parathyroid disease.

Unfortunately a lot of patients who feel rough, tired and lacking in energy feel that it must be parathyroid disease because the symptoms match.  This is not a reasonable assumption - UNLESS the calcium level is HIGH.

There are many, many causes for these vague symptoms one of which is parathyroid disease which can be easily cured.

It is incredibly rewarding to be able to undertake surgery in someone who is suffering with such symptoms and watch them be cured virtually overnight.

www.bucksendocrine.com

www.thyroidsurgeon.org.uk

Surgeon Outcome Data

Surgeons in the UK are about too publish specific outcome data in an open and transparent way.

The British Association of Endocrine and Thyroid Surgeons is at the forefront of this exciting development as our organisation has run a National Database publishing reports on volume of work and outcomes for some years.

I have presented below my personal graphs which will also be available shortly on the websites run by the NHS.

The data shows:

1. Large volume of thyroid surgery undertaken - above the 90th centile:

2. Low Rate of Permanent Hypocalcaemia after Total Thyroidectomy

3.  Short length of stay - majority daycase - after thyroid surgery

This type of data publication can only be helpful as the National Database shows that a number of surgeons in the UK operate on thyroids only occasionally.  I believe as does the BAETS that thyroid surgeons should undertake a significant volume of operating each year.

Further information is avalable on my websites:

www.bucksendocrine.com

www.thyroidsurgeon.org.uk

Sestamibi and Ultrasound Scans

Sestamibi Scans and Ultrasound Scans.

Sestamibi and ultrasound scans are used to plan surgery in primary parathyroid disease.

These scans are not to be used for diagnosis - except under very rare and specific circumstances by the surgical team.

Scans should not be used to determine who should have, or who should not have parathyroid surgery.  Parathyroid scans will often fail to identify the usually single offending gland - so what - well if you are with an experienced parathyroid surgeon this will not put them off and indeed cure rates should still be excellent.

I do use scans to help plan surgery and indeed to hopefully facilitate minimal access parathyroid surgery.  The scan images below show how in the top images a parathyroid adenoma can be seen on Sestamibi scanning and in the bottom image the ultrasound shows the 3D appearance.

  

Scan quality is crucial.  I have seen a number of scans from hospitals which undertake small volumes of parathyroid imaging where the scans are of poor quality.  This is not helpful as parathyroid adenomas may be missed on poor quality scans.  Ideally all scans would be undertaken in centres where large numbers of scans are done each year and the surgeon and endocrinology team jointly review cases to discuss findings with the radiologists.  This type of MDT (multi-disciplinary) team approach has been shown in many fields to improve outcomes.

www.bucksendocrine.com

www.thyroidsurgeon.org.uk 

Parathyroid Disease and Normal Calcium Levels

Traditionally most people have thought that to have a diagnosis of hyperparathyroidism or primary parathyroid disease you had to have a high level of calcium in the blood.

This is generally true.

However, there is a small group of patients who's calcium levels can be in the normal range yet they still have the disease.  It is important to remember that a normal range only ever encompasses 95% of the population.  So some people (2.5% of the population) are going to be above and the similarly some (2.5%) will be below the lab standard values.

Blood test result must always be taken in conjunction with the symptoms and therefore the reason for doing the test in the first place.

Reasons for calcium levels being 'normal':

1.  Levels fluctuating naturally day to day around the top end of normal so sometimes being inside normal range.

2. Low levels of vitamin D

3. High levels of calcium excretion by the kidneys therefore continually flushing calcium out of the body

4. Drug medication e.g., bisphosphonates, alendronic acid


So how can the diagnosis be confirmed.  Mainly by careful analysis of a series of blood and urine tests, consideration also being given to how these fit with symptoms.

Supporting evidence can be gained from bone density scans, parathyroid imaging etc.

www.bucksendocrine.com