Aa
Vanessa MD please respond/ hyperparathyroid
I never post on this forum - but to another members advice after my ordeal lately I thought I would give it a try.
I was a hyperthyroid patient in 2003 - RAI 2004 and now hypo. I recently had a ultra scan that had shown a "nodule" or so thought. I went for FNA monday. RAdiologist doing the biopsy chose not to complete the biopsy due to his thoughts that this was a hyperparathyroid situation - not nodule. I have class A symptoms of this disease. If confirmed which takes a while - that it could be hyperparathyroid - I have read this disease effects the kidneys tremendously. I believe that I have been having kidney tenderness for over a year. Sought treatment - only to be Dx'd with a UTI.
How do you feel I can protect my bones - heart and kidneys from further damage until this parathyroid situation is either confirmed or denied? Due to this wonderful radiologist recommendation to personally call an endo associate and get me seen right away - I have an appt Friday!! The radiologist has been in close conversation with me since the attempt of the FNA. I was terribly ill and he believes he may have knicked the gland allowing it to spill out PTH and calcium into my blood. Urination and hyperness have been unbearable until today and are calming down.
What should I be doing to protect myself until the waiting is over?
I was a hyperthyroid patient in 2003 - RAI 2004 and now hypo. I recently had a ultra scan that had shown a "nodule" or so thought. I went for FNA monday. RAdiologist doing the biopsy chose not to complete the biopsy due to his thoughts that this was a hyperparathyroid situation - not nodule. I have class A symptoms of this disease. If confirmed which takes a while - that it could be hyperparathyroid - I have read this disease effects the kidneys tremendously. I believe that I have been having kidney tenderness for over a year. Sought treatment - only to be Dx'd with a UTI.
How do you feel I can protect my bones - heart and kidneys from further damage until this parathyroid situation is either confirmed or denied? Due to this wonderful radiologist recommendation to personally call an endo associate and get me seen right away - I have an appt Friday!! The radiologist has been in close conversation with me since the attempt of the FNA. I was terribly ill and he believes he may have knicked the gland allowing it to spill out PTH and calcium into my blood. Urination and hyperness have been unbearable until today and are calming down.
What should I be doing to protect myself until the waiting is over?
Here are the questions I would appreciate some guidance on. It seems I am totally confused on how to go and need your opinion desperately.
A short background on my thyroid disorder. 2003 Dx/Graves - 2004 RAI - present Hypothyroid (3/2008 sub clinical 3.34) medically induced. Taking Armour meds since Oct 2007. Feb 2008 I requested an ultra sound due to "feeling of something stuck in throat" In the past have I expressed this with 2 endos- GI - ENT and many MD/PA's
Results/ Findings : on Feb 2008 US - The right lobe measures 2.2c1.0c0.9cm It has mildly heterogeneous echo texture and margins are indistinct. There is an increase vascularity associated with it . Left lobe measures 3.4x1.6x0.9 cm In lower left pole well circumscribed oval isoechoic nodule 11x10x8 . Mildly increased vascularity. Remainder of left lobe /mildly heterogeneous echo texture. Isthmus appears quite atrophic. There does not appear to be a mass effect by the thyroid or the left thyroid nodule upon adjacent strictures. Decreased size of the thyroid due to RAI or thyroiditis.
Solitary 1cc solid nodule in the lower left pole. It's isoechoic echo texture suggests benign lesion, but amenable to US-guided FNA if desired.
Attempt an FNA - March 3
Findings: Multiple attempts made at location with US guided needle biopsy but due to the deep posterior location and size I (the radiologist) was unsure if the needle tip was in the lesion itself. (this report just goes on on how he could not obtain a sample after 7 agonizing tries.) He does note at the bottom that "Note is made that the lesion may represent a parathyroid adenoma."
Due to further tests the hyperparathyroid situation is not an issue. I had all the appropriate tests:
VitD (37.5), (2) serum (9.3and9.5) and ionized calcium(1.26), phosphorus(3.5) PTH (25) all coming back normal.
During the FNA procedure they radiologist (s) and the US tech urged me not to continue the procedure due to the their thoughts of the parathyroid issue. It was the most traumatic biopsy anyone could have had and took over 30 minutes to finally stop trying. I was bruised from my Adam's apple to left collarbone and the pain during the attempt was unbelievable. The FNA report goes on the say the due to the nodule being in the posterior left lobe adjacent to the carotid artery FNA is very risky to achieve a sample. After the FNA attempt I suffered 72hrs of complete hyperactivity and was told that may be due to the probing,
TSH or PTH (if parathyroid) may be leaking out into the blood stream.
From the US reports - what are your feelings about the nodule itself?
Should I be "overly concerned this is cancer by what the first US report says? (solid 1cc) RAI/2004 etc.
Due to the deep lesion and an attempt made with no success - should surgery be optional instead of a second FNA?
Can a nodule still produce TSH if the thyroid is in a hypo state due to RAI and medication induced?
Should a CT/MRI scan be preformed to determine a hot or cold status to the nodule prior to a risky second attempt with another FNA?
I am so unsure who to listen to- I have so many doctors and none of them are communicating with each other.
MD is not concerned on the findings of the original report. (wait and see approach)
ENT surgeon says I am a greater risk of it being cancer due to RAI - from the first report. urged FNA and ordered.
Radiologist states parathyroidism / do not advise another attempt- (he even went as far to say - quote: "If you were my sister - this procedure would have never been done!"
Endo says nothing except repeat biopsy in 4 weeks and quit being anxious. ( not a very personable doctor)
Also the US from the FNA stated by the radiologist that:
the nodule was posterior to the lower left bed adjacent to the cortide artery.
Could this nodule be the cause of my constant mild achey headache (only left side), slight dizzyness, inflammation/stiffness of left back of neck and left chest/arm pit achey pain. I have had these symptoms for 2 yrs constantly and every physician I have seen have no explaination.
A short background on my thyroid disorder. 2003 Dx/Graves - 2004 RAI - present Hypothyroid (3/2008 sub clinical 3.34) medically induced. Taking Armour meds since Oct 2007. Feb 2008 I requested an ultra sound due to "feeling of something stuck in throat" In the past have I expressed this with 2 endos- GI - ENT and many MD/PA's
Results/ Findings : on Feb 2008 US - The right lobe measures 2.2c1.0c0.9cm It has mildly heterogeneous echo texture and margins are indistinct. There is an increase vascularity associated with it . Left lobe measures 3.4x1.6x0.9 cm In lower left pole well circumscribed oval isoechoic nodule 11x10x8 . Mildly increased vascularity. Remainder of left lobe /mildly heterogeneous echo texture. Isthmus appears quite atrophic. There does not appear to be a mass effect by the thyroid or the left thyroid nodule upon adjacent strictures. Decreased size of the thyroid due to RAI or thyroiditis.
Solitary 1cc solid nodule in the lower left pole. It's isoechoic echo texture suggests benign lesion, but amenable to US-guided FNA if desired.
Attempt an FNA - March 3
Findings: Multiple attempts made at location with US guided needle biopsy but due to the deep posterior location and size I (the radiologist) was unsure if the needle tip was in the lesion itself. (this report just goes on on how he could not obtain a sample after 7 agonizing tries.) He does note at the bottom that "Note is made that the lesion may represent a parathyroid adenoma."
Due to further tests the hyperparathyroid situation is not an issue. I had all the appropriate tests:
VitD (37.5), (2) serum (9.3and9.5) and ionized calcium(1.26), phosphorus(3.5) PTH (25) all coming back normal.
During the FNA procedure they radiologist (s) and the US tech urged me not to continue the procedure due to the their thoughts of the parathyroid issue. It was the most traumatic biopsy anyone could have had and took over 30 minutes to finally stop trying. I was bruised from my Adam's apple to left collarbone and the pain during the attempt was unbelievable. The FNA report goes on the say the due to the nodule being in the posterior left lobe adjacent to the carotid artery FNA is very risky to achieve a sample. After the FNA attempt I suffered 72hrs of complete hyperactivity and was told that may be due to the probing,
TSH or PTH (if parathyroid) may be leaking out into the blood stream.
From the US reports - what are your feelings about the nodule itself?
Should I be "overly concerned this is cancer by what the first US report says? (solid 1cc) RAI/2004 etc.
Due to the deep lesion and an attempt made with no success - should surgery be optional instead of a second FNA?
Can a nodule still produce TSH if the thyroid is in a hypo state due to RAI and medication induced?
Should a CT/MRI scan be preformed to determine a hot or cold status to the nodule prior to a risky second attempt with another FNA?
I am so unsure who to listen to- I have so many doctors and none of them are communicating with each other.
MD is not concerned on the findings of the original report. (wait and see approach)
ENT surgeon says I am a greater risk of it being cancer due to RAI - from the first report. urged FNA and ordered.
Radiologist states parathyroidism / do not advise another attempt- (he even went as far to say - quote: "If you were my sister - this procedure would have never been done!"
Endo says nothing except repeat biopsy in 4 weeks and quit being anxious. ( not a very personable doctor)
Also the US from the FNA stated by the radiologist that:
the nodule was posterior to the lower left bed adjacent to the cortide artery.
Could this nodule be the cause of my constant mild achey headache (only left side), slight dizzyness, inflammation/stiffness of left back of neck and left chest/arm pit achey pain. I have had these symptoms for 2 yrs constantly and every physician I have seen have no explaination.
MEDICAL PROFESSIONAL
Hi,
Prior to an FNA, the ultrasound scan should be able to show that the thyroid nodule based on the imaging results require a biopsy( that is establish an indication).Usually nodules less than 1 cm may need no further evaluation.However, in the presence of signficant TSH and FT4 levels, then an FNA may be done. Scintigraphy ( shows warm or cold ) may be done if the TSH levels may show possible disease.In your case, how large is this nodule? The size and character of the nodule based on the scan shall guide your physician in managing your condition.The location of the nodule to be biopsied has to be well ascertained prior to the procedure.
Prior to an FNA, the ultrasound scan should be able to show that the thyroid nodule based on the imaging results require a biopsy( that is establish an indication).Usually nodules less than 1 cm may need no further evaluation.However, in the presence of signficant TSH and FT4 levels, then an FNA may be done. Scintigraphy ( shows warm or cold ) may be done if the TSH levels may show possible disease.In your case, how large is this nodule? The size and character of the nodule based on the scan shall guide your physician in managing your condition.The location of the nodule to be biopsied has to be well ascertained prior to the procedure.
Hello - been a while since I posted a thread so................ tests results on the parathyroid issue
Calcium serum 9.5 range 8.4-10.2 normal
ionized calcuim 1.26 range 1.17-1.31 normal
Vit D 37.5 greater than 30 normal
**PTH 25 range 14-72 normal
Phosphorus 3.5 range 2.5-4.5 normal
So we are back to square one - no hyperparathroid issue. I have one nudule 1cc solid mass - no measure of hot warm or cold vascularity.
I get the call from the Endo I saw (he was the unhappy one on the Armour Thyroid issues) He has recommended another FNA (remember the frist one was unsuccessful due to the deep location. 7 tries to pull a sample with no success) No further treatment can/will be done with him unless another try on the FNA.
So here is what I need direction with and in your best opinion what options would you suggest.
Calcium serum 9.5 range 8.4-10.2 normal
ionized calcuim 1.26 range 1.17-1.31 normal
Vit D 37.5 greater than 30 normal
**PTH 25 range 14-72 normal
Phosphorus 3.5 range 2.5-4.5 normal
So we are back to square one - no hyperparathroid issue. I have one nudule 1cc solid mass - no measure of hot warm or cold vascularity.
I get the call from the Endo I saw (he was the unhappy one on the Armour Thyroid issues) He has recommended another FNA (remember the frist one was unsuccessful due to the deep location. 7 tries to pull a sample with no success) No further treatment can/will be done with him unless another try on the FNA.
So here is what I need direction with and in your best opinion what options would you suggest.
MEDICAL PROFESSIONAL
Hi,
Your symptoms are nonspecific but with a history of a thyroid problem and previous instrumentation one may be thinking of a parathyroid involvement.
Parathyroid problems may present with headaches, fatigability and memory loss.Depression and sleep disruption may also be present. This serum calcium level that was determined, is this total or ionized calcium ? Is the unit used in mg/dl or mmol/l?
Was serum albumin level also determined?
Parathyroid disease may be primary, secondary or tertiary.
Primary Hyperparathyroidism is due to a defect within the gland itself.Secondary and tertiary forms are due to decreased circulating calcium levels that may cause a feedback loop to the gland telling it to produce more hormones to increase blood calcium.This causes parathyroid gland hyperactivity and eventual enlargement.
Your serum calcium at this point is normal which is why no further intervention is really indicated with regards to assessing you along this line.
Discuss this with your endocrinologist and keep us posted regarding physician's advice.
Your symptoms are nonspecific but with a history of a thyroid problem and previous instrumentation one may be thinking of a parathyroid involvement.
Parathyroid problems may present with headaches, fatigability and memory loss.Depression and sleep disruption may also be present. This serum calcium level that was determined, is this total or ionized calcium ? Is the unit used in mg/dl or mmol/l?
Was serum albumin level also determined?
Parathyroid disease may be primary, secondary or tertiary.
Primary Hyperparathyroidism is due to a defect within the gland itself.Secondary and tertiary forms are due to decreased circulating calcium levels that may cause a feedback loop to the gland telling it to produce more hormones to increase blood calcium.This causes parathyroid gland hyperactivity and eventual enlargement.
Your serum calcium at this point is normal which is why no further intervention is really indicated with regards to assessing you along this line.
Discuss this with your endocrinologist and keep us posted regarding physician's advice.
Orginally Dx / Graves in 2003 - RAI to ablate thyroid in 2004 - now hypothryoid - not yet at euthryoid in 5 years - last TSH 3.82 2/08.
Symptoms - headache - mild/ all day-everyday acid reflux/ feeling not well / knee pain and back bone achey ( really all over body aches) freq bathroom AM breaks. moning anxiety - I feel 100 yrs old and only 42. Fog head - shot term memory problems. These are the major symptoms - but have a few other mild ones too.
Serum calcium test 3/3/08 9.3 (normal) no other PTH or other test done - due to the normal 9.3 test. SIt and wait........ per MD
Two Radiologist suspected hyperparathyroid - not nodule off of ablated thyroid. I believe your last paragraph is the option if gland has been injured which the preforming radiologist doing FNA suspects. I have been suffering tremondous symptoms since the FNA.
Comment from Radiologist. Quote : " if you were my sister, this procedure would never been done.".... unquote.
MD not moving on additional testing.b/c of normal serum calcuim.. ENT who ordered FNA - has not called me back since FNA - MArch 3 after I repeatedly called his office everyday to see what's next. RAdiologist has called everyday seeing if I could get an appointment to get that looked at after FNA. He arranged and endo appt for this Friday for me with NO REFFERAL. Now waiting to see what will happen with endo.
any thoughts or do you have advice on what I should be talking about with endo?
Symptoms - headache - mild/ all day-everyday acid reflux/ feeling not well / knee pain and back bone achey ( really all over body aches) freq bathroom AM breaks. moning anxiety - I feel 100 yrs old and only 42. Fog head - shot term memory problems. These are the major symptoms - but have a few other mild ones too.
Serum calcium test 3/3/08 9.3 (normal) no other PTH or other test done - due to the normal 9.3 test. SIt and wait........ per MD
Two Radiologist suspected hyperparathyroid - not nodule off of ablated thyroid. I believe your last paragraph is the option if gland has been injured which the preforming radiologist doing FNA suspects. I have been suffering tremondous symptoms since the FNA.
Comment from Radiologist. Quote : " if you were my sister, this procedure would never been done.".... unquote.
MD not moving on additional testing.b/c of normal serum calcuim.. ENT who ordered FNA - has not called me back since FNA - MArch 3 after I repeatedly called his office everyday to see what's next. RAdiologist has called everyday seeing if I could get an appointment to get that looked at after FNA. He arranged and endo appt for this Friday for me with NO REFFERAL. Now waiting to see what will happen with endo.
any thoughts or do you have advice on what I should be talking about with endo?
MEDICAL PROFESSIONAL
Hi,
Just to clarify, you have been initially suspected to have hyperthyroidism but later the diagnosis seems to have shifted towards a parathyroid problem. Is this correct?
What were your initial symptoms? Chief complaints?
How high are your serum calcium levels on evaluation?
Have you been diagnosed with a kidney disease prior to the findings of a possible parathyroid problem?
At this point, it is necessary to ascertain what could have caused the hyperparathyroidism. There are various causes and the management of each cause does vary. I suggest that you discuss this with your physician. The management for hyperparathyroidism usually depends on your serum calcium levels. At this point, we are not yet sure if hyperparathyroidism is indeed present. And if it is present its underlying cause has to be ascertained so that proper management will be given.
I can not exactly give you a specific advice regarding your concern of protecting yourself from the effects of a possible hyperparathyroid situation. At this point, the condition itself still remains a differential. This is a case in which your physician is best able to guide you. As I have mentioned, if a hyperparathyroidism situation is present management still varies.If parathyroid problem came up due to an injury to the gland then surgical intervention may be an option.
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