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Study on PHTP v Secondary HPT diagnosis

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Post by Johnny1967 Fri Jun 06, 2014 6:21 pm

http://www.ncbi.nlm.nih.gov/m/pubmed/23021135/

This link is to the abstract, the full article is on the web but when I post the link here it takes you to a subscription page. If you find it on the web yourself it's free. Worth a read if you're not sure on surgery or whether scans mean much for diagnosis.

An adenoma or other para abnormality on a MIBI or US doesn't always mean primary HPT.



Last edited by Johnny1967 on Fri Jun 06, 2014 6:43 pm; edited 3 times in total

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Post by Jasmine2 Fri Jun 06, 2014 6:42 pm

Now that was a really interesting read John and definitely food for thought ..... mmmm! Actually Dr Norman always advocates that localised imaging should never be used to confirm a diagnosis, only as a surgical guidance once the diagnosis has been made from biochemistry.

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Post by Johnny1967 Fri Jun 06, 2014 6:48 pm

The whole imaging thing is overrated I think. Might explain the many horror stories of people going hypo after surgery even though a juicy para has been removed.

BTW good luck in your latest challenge Jasmine.

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Post by Admin Fri Jun 06, 2014 6:49 pm

Thanks Johnny.

This has been added to the reference section useful website links.

Edwin
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Post by Tigerlily Sat Jun 07, 2014 10:17 pm

As I understand it, the difference between primary and secondary HPT is that in secondary HPT the calcium will be low.

It begs the question of course of what is a low calcium level. My endo is trying to tell me that a calcium level of 2.45 is not high - and therefore low!!

Methinks they have convinced themselves I have secondary PTH, will not be moved from this brain groove, and are trying to make my bloods fit their (possibly incorrect) diagnosis.

Hey. ho.   Hmmmmm ...

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Post by Admin Sun Jun 08, 2014 10:34 am

I think you will find that 'high' in the context of blood results means above the range and not at the upper area of the range.
Anything within the range is 'fine', 'normal', etc.
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Post by Tigerlily Sun Jun 08, 2014 11:03 am

Thanks, Edwin - I always wondered what "high" and "raised" meant, in the context of blood results.
So "raised" would be at the top end of the range, maybe?

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Post by Admin Sun Jun 08, 2014 1:44 pm

Hmmm.  Not so sure about "raised".

When you get printouts of your blood results, the "high" and "low" results are identified by the blood lab (with an asterisk, or different colour).

In theory, GPs should use the results as guidance, but in conditions where they are out of their depth, e.g. Thyroid and Parathyroid diseases, they tend to take more notice of the blood results than they do of the patient's symptoms.

Edwin


Last edited by Admin on Sun Jun 08, 2014 5:44 pm; edited 1 time in total
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Post by Little Audrey Sun Jun 08, 2014 2:21 pm

No, scans should not be used for diagnostic purposes. Although, after fighting with my doctors for 3 years to obtain that diagnosis, I was more than ready to have a scan in hopes something would be revealed and end that Hell for me. I would have been more than happy to have a surgeon perform exploratory surgery to look for a tumor. I KNEW there was at least 1 in there! I am happy I held off on the scan, as it would have probably been negative anyway, since the 1 I had the morning of surgery was negative, but I was very tempted to give it a shot many times before surgery.

Great article, Johnny!

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Post by Johnny1967 Sun Jun 08, 2014 2:54 pm

Hi Audrey, One question I'm itching to ask. If the article is correct and many people have enlarged glands or positive scans but do not have PHPT, what numbers would you have been comfortable with before saying yes to exploratory. I've seen recent first hand accounts of people paying for what amounts to elective exploratory surgeries with numbers that do not remotely fit even normocalcemic HPT.

By that I mean very normal less than mid range total ca and pth.

Thanks, John

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Post by Little Audrey Mon Jun 09, 2014 2:58 am

Well, John,  That is a very good question.  My PTH levels were all inappropriately high for all of my calcium levels.  So I was pretty darned sure I had at least 1 tumor in my neck.   I was more than ready for someone to open me up and take a good look inside to search for a tumor.

As bad as my symptoms were (and some still are), I think I would have opted for exploratory surgery regardless of my lab results if something was revealed on a scan.   I would have been willing to take the chance on them not finding a parathyroid tumor by going in and taking a look around.   I would hope they might find SOMETHING abnormal and remove it.   I guess I would look at it as, I couldn't possibly be any worse off if they went in and didn't find a parathyroid tumor.   Yes, I would definitely have opted for exploratory surgery had something been revealed on a scan.   Labs would not have mattered to me.   Desperation would have played a big part in that decision.  

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