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Doc Talk - Know your parathyroid

Look for the right cause... Photo: Special Arrangement  

Around eight years ago, I first noticed that I felt an unexplained tiredness at the end of the day. For someone accustomed to working long hours, this was rather unusual. I often felt listless, was unable to concentrate, was increasingly irritable and had a poor appetite. I also found it hard to sleep. I had severe cramps and pain in my feet and legs. On some days I found myself close to crying for inexplicable reasons. Unsurprisingly, this interfered with my work and I found myself taking longer to complete simple tasks. My family was puzzled by this change and wondered if I was depressed.

Diagnosis

A few months later, I developed severe pain in my abdomen. All the relevant investigations including a whole body scan drew a blank. All the basic tests for diabetes and other common problems yielded no positive results. Then my husband suggested that I measure my parathyroid hormone (PTH). Sure enough, it was very high; 3-4 times the normal value. My calcium levels were also high. A diagnosis of hyperparathyroidism was made.

However there was no medical treatment for this. Since my Vitamin D levels were low, which could also explain bone pain, I was given medication to keep Vit D and calcium levels in the normal range. In the bloodstream, the excess calcium organised itself to form calculi (stones) and I developed intermittent and severe pain due to the ureteric calculi. They were removed surgically a couple of times.

Over the next few years, I suffered from periodic pain. I used to be particularly apprehensive about international travel and was lucky to have no untoward episodes away from home.

A growth in the parathyroid gland called an adenoma is the commonest cause of hyperparathyroidism. These are normally revealed by a special scan called the system bee. However, three such scans did not seem to reveal an adenoma. Opinion among local doctors was divided on whether I should opt for surgery or not. In the meantime, my health began to fail gradually and I decided to take the plunge. A specialised centre in Florida in the US went through my records and urged me to have surgery at the earliest. A large adenoma was found and my right upper parathyroid gland was removed along with the adenoma. The surgeons felt I should have had this surgery years ago, which would have spared my bones and prevented calculi.

The surgery itself was uneventful and I have been in reasonably good health since then, although I still have to deal with the existing calculi and the osteoporosis. My PTH and calcium levels are normal now. I have not felt as well in many years now.

Lessons to learn

There are some important and interesting lessons from this. Problems of the parathyroid are not well known, even among the medical community. Since it presents either as bone pain, exhaustion or renal calculi, it is often treated symptomatically without the underlying problem being addressed. There is often a huge delay in diagnosis. Equally common seems to be low Vit D levels in the Indian population, an irony considering that sunlight is the best source of Vit.D. Although the incidence is one in 1000, many doctors say that they have not seen many persons with primary hyperparathyroidism.

When you see fatigue, bone pain, depression, urinary calculi and vague discomfort, think of the parathyroid and make the relevant investigations. Early diagnosis can reduce pain and distress and prevent damage to several vital organs.

What you should know

There are 4 parathyroid glands. Except in rare cases, they are in the neck behind the thyroid.

Parathyroid glands are NOT related to the thyroid. They control the amount of calcium in your blood and bones.

Parathyroid glands make a hormone called Parathyroid Hormone (PTH), which has a normal range in the blood.

Removing all parathyroid glands causes symptoms of too little calcium (hypoparathyroidism), which is very rare. When there is problem with the glands, it is usually one gland that develops a benign tumour and secretes too much hormone. In rare cases, hyperparathyroidism may affect two glands.

When one gland secretes too much hormone, the excess goes to the bones and leaches calcium out and puts it in the blood. This leads to osteoporosis.

The tumour never develops into cancer; so stop worrying about that! However, not removing the tumour and leaving the calcium high for a number of years will increase the chance of developing other cancers.

There is only ONE way to treat parathyroid problems: Surgery.

Source: >www.parathyroid.com

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Printable version | Nov 20, 2020 9:23:10 AM | https://www.thehindu.com/features/magazine/doc-talk-know-your-parathyroid/article2635484.ece

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