In this episode of PodMD, experienced Endocrine Surgeon and Surgical Oncologist A/Prof Anthony Glover will be discussing the topic of when you should order a parathyroid test, including what the test is, what a GP should be looking out for and more.
Please note this is a machine generated transcription and may contain some errors.
*As always, all in this PODMD podcast is intended for health professionals and the comments are of a general nature. Information given is not intended as specific medical advice pertaining to any given patient. If you have a clinical issue with one of your patients please seek appropriate advice from a colleague with expertise in the area.
Today I’d like to welcome to the PodMd studio Dr Anthony Glover, Dr Glover is a practicing Endocrine Surgeon and Surgical Oncologist. Anthony specialises in the care of thyroid, parathyroid and adrenal disease, endocrine cancer biology and the development of surgical competencies and professional skills.
Today, we’ll be discussing the topic of when you should order a parathyroid test.
*We do hope you enjoy this podcast but please remember that the advice here is of a general nature and is not intended as specific advice about a given patient. The views and opinions expressed in this podcast are those of the doctor, not PodMD.
If you do have a patient on whom you require specific advice, then please seek advice from a colleague with appropriate expertise in that area.
Anthony, thanks for talking with us on Pod MD today.
Anthony: Thank you for having me
The topic of today’s discussion is when should you order a parathyroid hormone blood test. Can you quickly go over what a parathyroid test is testing for?
Anthony: She also, the parathyroid hormone test is testing the parathyroid hormone levels in the blood. So then sometimes raised, um, if you have either an enlarged, um, or an overactive parathyroid gland, uh, and it’s quite a common condition, um, that’s often not diagnosed. Um, so it’s, I think important that, uh, that GPS are aware of it. And now the doctors are aware of it that, um, trait patients, because it can present me in a number of different ways. The parathyroid hormone levels can also be raised in the setting of vitamin D deficiency as well.
How does the test work?
Anthony: Yeah, so it’s just a blood test. So, um, it’s done, um, it can be done with other routine blood tests, um, and most pathology labs offer it. Uh, there’s no special preparation, uh, for the patients to have the test. Um, and yeah, and often is done and other panels of bloods, um, such as when checking calcium or, uh, renal function
What should a GP be looking out for? Any red flags or quick hints for what GPs should be looking out for?
Anthony: Yeah. So having ordering a parathyroid hormone tests, you should be considered when you think the patient may have hyper parathyroid ism. So, uh, and an elevated parathyroid hormone level, the thing is, is can be very vague with the symptoms. So as the disease gets more advanced, um, you often see symptoms, um, but that can mean there’s damage onto the underlying organs and that damage can be present, present with any illnesses that related to calcium metabolism. So the most common ones where you would see with the patients with osteoporosis, um, or recurrent kidney stones, often they, um, have underlying hypoparathyroidism, um, which can be easily diagnosed by doing a parathyroid hormone level. Uh, but because potentially hasn’t been thought of before often, it’s not done for many years for patients that have more mild milder disease, they may present with more subtle symptoms that that are not, um, obviously related to calcium.
So some of those symptoms can be chronic abdominal pain feeling very tired, easily, or, or weakness, um, feeling depressed or forgetful, um, having bone or joint pain, or just feeling generally unwell and also having nausea, vomiting, loss of appetite. So what are those symptoms? They just gradually get worse. Uh, and obviously they’re not the first thing a parathyroid hormone level is not the first thing that people would think about with those symptoms, but for patients who have these recurrent symptoms that are just gradually getting worse, it’s worthwhile thinking, could this patient have, um, hyperparathyroidism or raised elevated parathyroid hormone level, which can be easily tested with a blood test
So, is there any time you would advise holding off on testing or is just go ahead with it?
Anthony: Yeah. In general, no. Um, I think hypoparathyroidism it’s often or hyperparathyroidism is often diagnosed before any end kind of stage signs or symptoms of the disorder are apparent. Um, so what that, that would be with osteoporosis or renal stones. So we want to try and intervene early. And for patients that we intervene with, which is we had surgery to remove the enlarged parathyroid, um, the underlying disease gets better. So for osteoporosis and recurrent renal stones, once, once the enlarged parathyroid is removed, then, um, it’s, it’s much less likely the patient’s patient will have any further renal stones and they in process osteoporosis also, um, improves.
Is there any time you would advise holding off on testing?
Anthony: Yeah, so it’s, it’s worthwhile doing the test first. Um, but all patients with a raised parathyroid hormone, um, should be referred to a specialist that’s interested in parathyroid disease. So usually it will be either an endocrinologist or endocrine surgeon. And for ju generally when we looking at a parathyroid hormone tests, we also want to have a look at the calcium level. So urgent referrals are needed when the patient has a very high calcium, um, which is usually a corrected calcium above three millimoles Belita or if the patient has significant symptoms, um, such as, uh, recurrent kidney stones or, or severe depression, some, um, JPS and, uh, and surgeons about localization studies to look at what parathyroid maybe, um, causing the raised parathyroid hormone. And you don’t need to order those before referring, uh, and for some patients, those other studies or those scans, maybe negative, uh, but they still need to be referred. Um, as often these patients will still benefit from surgery and from having the enlarged enlarged parathyroid removed. Uh, so those patients always should be referred.
Thank you for your time here today in the PodMD studio. To sum up for us, could you please identify the three key take home messages from today’s podcast on when you should order a parathyroid test
Anthony: Yeah, I think given it’s an easy test to do. I think if you have, uh, any suspicion that your patient may have a high calcium level or any kind of symptoms or diseases that fit with hyperparathyroidism, you should order a parathyroid hormone test. And just remembering often these diseases aren’t diagnosed until the patient gets renal stones or osteoporosis. Um, so the earlier we can intervene, we can potentially avoid patients having these problems. If the second point is if the patient has a raised, uh, PTH with OEA arrays, calcium, they should see you should seek referral, um, either to an endocrinologist or endocrine surgeon, so they can be further assessed. And the final thing is you don’t need to do different localization studies or scans to refer. And even if those tests are done and they’re negative, the patients still be referred because they may have more than one, uh, enlarged parathyroid. That’s not apparent on the scans. Uh, and most likely they’ll be able to be cured by surgery
Thanks for your time and the insights you’ve provided.
Anthony: Thanks for that