WWTBAM Bored

Anybody here ever have to deal with this?

As you might suspect, it has to do with my mom.

Back in the 1930's-40's, when my Mom was a teenager, they didn't know nearly as much about radiation safety as they do now. And they sometimes did radiation therapy for acne!

40/50/60 years later, many of those folks who had this treatment ended up with thyroid cancer (or other thyroid/parathyroid problems.) Mom had a non-cancerous nodule, and her thyroid was removed surgically when she was in her late 60's (she turned 84 this past Saturday.) She takes Synthroid & is fine. Her major complaint after "having her throat cut!" was that one of her laryngeal nerves was damaged & she lost her singing voice -- she ended up resigning from her beloved church choir.

I'm also dealing w/ a couple of folks on my job who have thyroid/parathyroid issues -- one of whom is my husband's cousin -- and will post a little more later. Right now I still have a little work to do!

nitrah55 wrote:Anybody here ever have to deal with this?

As you might suspect, it has to do with my mom.

As an endocrinologist, I deal with this issue regularly. Feel free to post or send me a private message.

nitrah55 wrote:Anybody here ever have to deal with this?

As you might suspect, it has to do with my mom.

Personally or in family, never

As a doc, frequently, since it is a not uncommon endocrine disorder.
The parathyroid glands are four little nubbins which lie at the back of the thyroid gland, and produce a hormone called PTH (parathyroid hormone) which is important in bone metabolism. The glands usually dont cause much trouble for anyone, but are responsible for problems in people with renal problems (secondary hyperparathyroidism), and cause problems when the usual feedback mechanisms are lost and too much PTH is made in people who have no other medical problems (primary hyperparathyroidism).

There is an inverse deficiency disorder (hypoparathyroidism), less commonly.

In the past, and in student teaching, the classic consequences of too much PTH were bony pain, ulcers and kidney stones (bones, stones and abdominal groans), but by far the most likely situation now is to find a slightly high calcium on a set of routine laboratory screenings. And then to note there is no other medically likely cause of this (lung cancer, sarcoidosis, myeloma etc etc), all of which are usually pretty self-evident.

And then, primary hyperparathyroidism becomes the classic surgical endocrine disorder, since the usual gland pathology is a small benign adenoma of one of the glands, take it out and you are cured.

There is probably new stuff to read on imaging, and on the decision of OR vs. watchful waiting, which I have not read, but what I have written above are the basics as I know 'em.

I will happily yield any claim to expertise to thguy

etaoin22 wrote:I will happily yield any claim to expertise to thguy

Oh yeah, I will too.

TH, if you're out there, this is mostly for you. And thanks for offering.

As part of moving Mom to another location (rehab to assisted living), she switched doctors. Less than a day after that, she was hospitalized with an attack of kidney stones. New doc diagnosed a para-thyroid problem, which he said could be causing the stones, HBP, lethargy- basically what's been ailing her for some time.

They've been treating the para-thyroid with Sensipar (which is usually reserved for dialysis patients). Doc is now talking about surgery to remove the gland, which leads me to believe that the Sensipar isn't working as he'd hoped.

I understand the surgery to be an outpatient procedure, lasting about 20 minutes- some people even do it under local.

Mom's 90, with no other chronic health issues. What can I expect her recovery to be like? What kind of treatment (with side effects) would she have to do to compensate for not having the gland any more? Is it reasonable to assume that her condition would continue to deteriorate if
she didn't have the surgery?

Again, thanks.

nitrah55 wrote:TH, if you're out there, this is mostly for you. And thanks for offering.

As part of moving Mom to another location (rehab to assisted living), she switched doctors. Less than a day after that, she was hospitalized with an attack of kidney stones. New doc diagnosed a para-thyroid problem, which he said could be causing the stones, HBP, lethargy- basically what's been ailing her for some time.

They've been treating the para-thyroid with Sensipar (which is usually reserved for dialysis patients). Doc is now talking about surgery to remove the gland, which leads me to believe that the Sensipar isn't working as he'd hoped.

I understand the surgery to be an outpatient procedure, lasting about 20 minutes- some people even do it under local.

Mom's 90, with no other chronic health issues. What can I expect her recovery to be like? What kind of treatment (with side effects) would she have to do to compensate for not having the gland any more? Is it reasonable to assume that her condition would continue to deteriorate if
she didn't have the surgery?

Again, thanks.

Nitrah:
There are typically 4 parathyroid glands in the neck (2 on each side), and most of the time only one of them is overactive. After the bad actor is removed, the other 3 glands (which have been basically dormant since they haven't needed to do any work) will start to function again normally, but in the short term your mom's calcium level may drop below normal as her bones start recovering the calcium from the blood that the excess parathyroid hormone caused to shift into the blood and out into her urine. She should take calcium supplements after the surgery, and watch for symptoms of low blood calcium such as tingling around her lips or in her hands/feet, muscle cramping or spasms. If those symptoms occur in spite of taking calcium supplements, she should contact her doctor.

Sensipar has FDA-approved to lower parathyroid hormone levels in patients with kidney failure (which causes overactive parathyroid glands due to Vitamin D problems) or in cases of parathyroid cancer (a very rare condition), although it will work for garden-variety benign overactive parathyroid glands. It's just not a standard long-term solution to the problem when a relatively simple surgery can cure the situation. If she continues to have high parathyroid hormone levels raising her blood calcium level, she can get worsening osteoporosis (increasing her risk of breaking bones easily), more episodes of kidney stones, general fatigue, persistent constipation, depression symptoms, and increased stomach acid issues. If she's healthy enough to tolerate the surgery, it's best to do it. The important thing is that a surgeon who does parathyroid surgery on a regular basis handles the operation. Some ultrasound or radio-isotope scans can help the surgeon know exactly which of the 4 parathyroid glands should be removed prior to the patient going to the operating room.

In the meantime, it's important that she drink lots of water (at least 64 oz per day if she can) to keep her calcium level in the blood diluted down and reduce the risk of more kidney stones.

Please let me know if you have other questions, and keep us posted.

Much thanks, Tim.