New minimally invasive approach to diagnose hyperparathyroidism

MedStar Washington Hospital CenterOct 24 2016

Almost all of us have four parathyroid glands, located next to the thyroid gland in the neck. They are an organ only the size of a grain of rice, but critical for controlling our body's calcium levels. Unfortunately, hyperparathyroidism - when an excess of parathyroid hormone is produced - goes undiagnosed or diagnosed late. This can be because many patients do not showcase apparent symptoms or their symptoms go unrecognized as being caused by hyperparathyroidism.

This is particularly troublesome for older patients, in particular, because women are the most at-risk for developing hyperparathyroidism until they have developed bone loss or kidney stones. So if you're a woman who is 65 years or older, how do you know if you have hyperparathyroidism? And most of all, what are the risks of remaining undiagnosed?

Signs of Hyperparathyroidism and Risks if Left Undiagnosed or Untreated

Parathyroid hormone plays a critical role in your body's metabolism of calcium. Hyperparathyroidism causes the loss of calcium from your bones and elevated calcium levels in your blood. For older patients, however, they may only experience depression, bouts of memory loss, as well as pain in their bones and joints.

Often, these symptoms are dismissed as signs of stress or other more benign troubles, and the option of a diagnosis of hyperparathyroidism is entirely overlooked.

The effects of hyperparathyroidism can result in other health concerns, if left untreated. In addition to kidney stones and osteoporosis, older patients may physical symptoms including depression, mood changes, fatigue, muscle, and bone aches and pains, or even cardiac dysrhythmias.

4D CT Scanning: A New Way of Diagnosing Hyperthyroidism

Traditionally, abnormal parathyroid glands were found using two distinct techniques. Ultrasound is the first technique, which involves rubbing a probe covered in gel over the neck to search for abnormal glands. Although it's a noninvasive procedure, it mainly relies on the size and general appearance of the gland to determine whether or not it's abnormal. The second approach is known as sestamibi scanning (also known as MIBI), which is designed to showcase an abnormal gland's overfunction. Although these two techniques together are relatively accurate for some, others still fail to see a productive result from either of these two techniques. Often patients get wrong or conflicting information from these studies alone, and we are left without a clear answer before surgery as to which parathyroid gland is the culprit.

A new technique known as 4D CT scanning can show both parathyroid gland structure and parathyroid gland function in a single test. However, because of the small amount of radiation exposure, it's typically reserved for patients who have not gotten definitive results via other means.

First, a preliminary scan is done for comparison purposes. Then a contrast material is injected into the patient's veins to follow its progress through the body. Scans are done two or three times after the injection, generally at 30- to 90-second intervals. Although complications can happen even in the best of hands, they are very rare for this kind of study, and patients go home while a radiologist examines the results.

Successes We've Seen at MedStar Washington Hospital Center

At MedStar Washington Hospital Center, many of our patients have gone a long time between being symptomatic and being diagnosed with primary hyperparathyroidism, as they had been given the wrong diagnosis or had unsuccessful operations performed elsewhere in the past. But in our work with 175 patients so far, we have found a high degree of accuracy in the 4D CT technique when the CT scan identifies an abnormal parathyroid gland.

This approach enables us to offer a minimally invasive approach to more patients with primary hyperparathyroidism or recurrent disease. This also gives us more confidence when going into surgery that we are likely to find the abnormal gland and cure the patient of their disease.