Parathyroid and Thyroid Disorders

[mis8231]

I went to my PCP for stomach problems. In routine blood tests he found high calcium (12.9). I had multiple symptoms of hypocalcimia and was told it is parathyroid disease. I went to an endocrinologist and they did another thyroid ultrasound and I was found to have possible large adenoma on my thyroid gland, right lobe, 2.6 cm x 3.2 with "increased vascularity".  The radiologist who did the report suggested that it is most likely an adenoma and recommended a thyroid nuclear scan to rule out cold nodule. I am scheduled for that next week and they haven't done an FNA, does that sound right? I am concerned and feeling very sick lately, from bone pain to upset stomach to major headaches, which I'm told are all due to the high calcium. I am waiting for an appointment with MD Anderson (I am in Houston), but that seems so far off and I just feel so sick and I'm extremely tired. I just feel nervous that the doctors aren't doing the right thing. I am not sure they are doing the right tests (the endo repeated all the tests the PCP had done the week before and also did an ECG). Because of all the people in and out of her office, I feel that my endo is almost a "mill", she had many patients all at once and they all get the same tests it seems.  Should I seek another doctor?  I just want to feel better again. I am 32 and feel like I'm at least 50.

[Mark Lupo, M.D.]

If the PTH is high, combined with the high Calcium, you have Primary Hyperparathyroidism --- most likely what they saw on ultrasound is a parathyroid adenoma which is over-producing PTH.  Your symptoms are consistent with this.  You are young and the endocrinologist should consider multiple endocrine neoplasia (rare, but worth looking into) -- ie, check calcitonin, prolactin and screen for pheochromocytoma.  MD Anderson will sort through all this with you -- good luck.

Fortunately, the treatment for Primary HPTH is a simple surgery often done under local anesthesia in about 15-20 minutes.  Check out parathyroid.com which has excellent information regarding this condition and its treatment.

[mis8231]

The MD Anderson doctor will be doing the surgery. It is a process just to get an appointment. You have to fax all your records and test results, they review them and then they put you in order of how critical your situation is. I have been waiting a week for an appointment, so I hope to be hearing something soon. I just want to feel better again, I feel so old and I have to take frequent naps.  I am sure they are doing what they think they ought to do, but from what I understand from reading up on it and from what the dr said, I think it's not a common problem so a lot of doctors don't have much experience in managing it.  I think I'll call MD Anderson on Monday and see if I can get some information regarding when I can be seen. Thanks for your reply and for your encouragement.

[mis8231]

I forgot to add that my PTH was 179.5, which I'm told is extremely high. I know I need the parathyroid surgery, I just want to know if all these tests they are doing are even necessary and why can't they just refer me to a surgeon, get the surgery and get it over. I'm so exhausted all the time and just tired of being sick. I'm also concerned about my kidney and bone health.

[jprod]

I am also from the Houston area (but, I'm not a doctor or health care professional).  

I have had a lot of health issues over the last few months, and was evaluated for thyroid and parathyroid issues.  From my reading up on these issues, your parathyroid numbers are WAY high, and your calcium is also very high.  It does sound like you will need a surgery to remove the parathyroid.  I have read that there is a minimally invasive surgery to remove the parathyroid gland that is causing the problems.  I would recommend that you discuss the minimally invasive procedure with your doc.

I have a good endocrinologist off of Holcombe (not sure if this is the same one you have).  If you are trying to get into another endo, most seem to be very busy and it may take a while to get in. Not enough endocrinologists in the Houston area.  I would recommend that you be assertive to see if you can get in any earlier for the nuclear study, and the appointment with the doctor at MD Anderson.  Be assertive, but be pleasant.  Perhaps if you explain the high numbers you have, and how bad you are feeling, maybe they will do what they can to schedule you earlier.  In fact, perhaps you could ask if you can just come in and see if the doctor can try to to "fit you in".  Or, you can ask if they have a waiting list in case there are any cancellations.  Just be pleasantly persistent. (I called my endo daily to get an earlier appt., and after 6 days of calling, they had a cancellation, and I got in the next day:)  I don't know who your endo is, but I do know that MD Anderson has some really great docs.  Is the MD Anderson doc the one who is supposed to do surgery for you?  Or, is the doc the one who is supposed to the fine needle aspiration?  I agree with you that it seems wierd not to have the FNA done -- I would call your doc and ASK QUESTIONS.  Arm yourself with information.  In my research, I found some really good websites that deal with parathyroid and thyroid issues.  I am a private individual, with absolutely NO interest of any type in these sites, just trying to b helpful, and refer you to a website that may answer your questions.  It answered many of mine.  ALSO - BE PERSISTENT.  ASK QUESTIONS.  Do whatever you can to be seen as soon as possible.  Here are the sites:

parathyroid.com  
endocrineweb.com/thyroid.html

I hope this is helpful.  Good luck to you.