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
Wednesday, 5 February 2014
Thursday, 27 June 2013
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
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
Saturday, 15 June 2013
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.
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.
Saturday, 8 June 2013
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
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
Saturday, 1 June 2013
Parathyroid Surgery Outcomes
Parathyroid Surgery
This type of surgery is complex and is best performed by surgeons with a particular interest in the disease. They should be backed up by a specialist team including endocrinologists, radiologists and radiographers.
Results from parathyroid surgery should be made available to patients and should demonstrate a cure rate of over 95%.
www.bucksendocrine.com
This type of surgery is complex and is best performed by surgeons with a particular interest in the disease. They should be backed up by a specialist team including endocrinologists, radiologists and radiographers.
Results from parathyroid surgery should be made available to patients and should demonstrate a cure rate of over 95%.
www.bucksendocrine.com
Monday, 23 April 2012
Referral Out of Area in the NHS
I get a lot of enquiries from patients who are wishing to transfer care from their local area.
The previous government set up a system called Patient Choice and as part of this set out a series of rights for patients within the NHS in England - Scotland and Wales are separate from this.
As part of Patient Choice (more details on the NHS website) every NHS patient is entitled to be referred by their GP to a consultant of their choice. This can be anywhere in England and your GP should not restrict you to just your local area.
In practice most GPs are entirely aware of the entitlements so as long as you are clear in what you would like to do this is not really a problem.
I encourage patients to be referred by their GP as this will allow for safe and efficient transfer of information - in particular past medical history, blood tests and other investigation results.
For patients from out of area we operate a very efficient service where I will endeavour to see you, undertake all tests the same day and then you simply come back for surgery - a 2 stop service!
Bucksendocrine - Thyroid and Minimal Access Parathyroid Surgery
Thyroid Surgery by a UK specialist surgeon
The previous government set up a system called Patient Choice and as part of this set out a series of rights for patients within the NHS in England - Scotland and Wales are separate from this.
As part of Patient Choice (more details on the NHS website) every NHS patient is entitled to be referred by their GP to a consultant of their choice. This can be anywhere in England and your GP should not restrict you to just your local area.
In practice most GPs are entirely aware of the entitlements so as long as you are clear in what you would like to do this is not really a problem.
I encourage patients to be referred by their GP as this will allow for safe and efficient transfer of information - in particular past medical history, blood tests and other investigation results.
For patients from out of area we operate a very efficient service where I will endeavour to see you, undertake all tests the same day and then you simply come back for surgery - a 2 stop service!
Bucksendocrine - Thyroid and Minimal Access Parathyroid Surgery
Thyroid Surgery by a UK specialist surgeon
Sunday, 18 March 2012
Calcium Levels and Diagnosing Parathyroid Disease
Calcium levels in the blood are controlled in a very tight range - in the UK levels are given on blood tests such that the normal range is between 2.2 and 2.55 mmol/l. This varies between laboratories and hospitals but not by much.
Key Point 1 - A high calcium is never normal
Calcium levels are controlled by the parathyroid glands which make parathyroid hormone (PTH). The 4 parathyroid glands have a really big blood supply and can monitor calcium levels really effectively. Contol of calicum is in a very narrow range.
Key Point 2 - Calcium levels will fluctuate on a day to day basis
So calcium levels if checked and are just outside normal can be rechecked and may a few days later be in the normal range. Some patients with parathyroid disease who have calcium levels that are marginally elevated will therefore dip into normal from time to time - this can make the diagnosis difficult.
Key Point 3 - What to do if calcium is high
Calcium levels should be rechecked along with a PTH level. If the calcium is high PTH levels should be almost zero because like your boiler their internal thermostat (measuring calcium not temperature) should have switched them off.
If PTH levels are in the 'normal' range and calcium is high you almost certainly have parathyroid disease as the calcium levels are inappropriately elevated as they should be near zero.
Key Point 4 - Symptoms are not linked to calcium level
Many patients will have marginally elevated calcium levels and yet have terrible symptoms. Some will have very high calcium and no symptoms. The absolute numbers are of no great relevance. All patients with parathyroid disease should have a discussion about treatment with someone who understands the disease.
More information on:
Parathyroid Surgery
Parathyroid and Minimal Access Thyroid Surgery
Key Point 1 - A high calcium is never normal
Calcium levels are controlled by the parathyroid glands which make parathyroid hormone (PTH). The 4 parathyroid glands have a really big blood supply and can monitor calcium levels really effectively. Contol of calicum is in a very narrow range.
Key Point 2 - Calcium levels will fluctuate on a day to day basis
So calcium levels if checked and are just outside normal can be rechecked and may a few days later be in the normal range. Some patients with parathyroid disease who have calcium levels that are marginally elevated will therefore dip into normal from time to time - this can make the diagnosis difficult.
Key Point 3 - What to do if calcium is high
Calcium levels should be rechecked along with a PTH level. If the calcium is high PTH levels should be almost zero because like your boiler their internal thermostat (measuring calcium not temperature) should have switched them off.
If PTH levels are in the 'normal' range and calcium is high you almost certainly have parathyroid disease as the calcium levels are inappropriately elevated as they should be near zero.
Key Point 4 - Symptoms are not linked to calcium level
Many patients will have marginally elevated calcium levels and yet have terrible symptoms. Some will have very high calcium and no symptoms. The absolute numbers are of no great relevance. All patients with parathyroid disease should have a discussion about treatment with someone who understands the disease.
More information on:
Parathyroid Surgery
Parathyroid and Minimal Access Thyroid Surgery
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