How is a patient diagnosed with parathyroid disease?

Classically, patients with a high serum calcium test are referred for evaluation to determine if they have primary hyperparathyroidism. A high serum calcium test indicates there is too much calcium circulating in the blood. Calcium levels in the blood that are elevated cause a variety of symptoms which are often overlooked. Elevated blood calcium levels cause fatigue and can affect the memory. Elevated calcium in the blood can also be responsible for depression and mood changes. Finally, there are situations where elevated calcium levels can result in renal stones. High calcium levels also affect energy levels. When calcium levels are too high, there is a clear indication of a primary problem that may be a result of hyperparathyroidism. However, even when there is normal blood calcium, there are situations where the patient may still have primary hyperparathyroidism. Ionized calcium levels are useful in this situation. Ionized calcium range is determined by each laboratory but it a more precise indication of calcium circulating within the blood. Parathyroid hormone levels are easily measured. If the results of the parathyroid hormone test and serum calcium test are examined together, the determination can easily be made to confirm the diagnosis of primary hyperparathyroidism. Endocrinologists typically would be involved in the workup for a high serum calcium test.

Parathyroid disease is relatively common and can occur in all ages. The parathyroid gland is typically as small as a grain of rice and only weighs approximately 20 mg. There are four parathyroid glands in most patients, but approximately 3% of patients may have more than four glands. A small percentage of patients have only three parathyroids. The parathyroid glands in the neck are typically located behind the thyroid gland. However, if parathyroid glands in the neck are not identified, a search is often made in the mediastinum.

Disease symptoms associated with hypercalcemia are diffuse. In severe cases, left ventricular hypertrophy may be associated. Too much calcium in the blood is associated with removal of calcium from bone stores. Blood calcium levels that are therefore elevated are indication that calcium has been taken out of the bone. Too much calcium in the body is often a misrepresentation. When calcium levels in the blood are elevated, the truth is that the total amount of calcium in the body is indeed not elevated. Calcium blood tests measure only circulating calcium but do not measure the amount of calcium deposits in the bone. Even ionized calcium levels and more specific ionized calcium tests do not determine the amount of calcium needed to maintain a healthy bone structure. With high parathyroid hormone levels, there is too much parathyroid hormone level circulating, and this results in calcium loss from the bones. Bone loss will result in osteopenia and the syndrome of osteopenia and osteoporosis can be a secondary result. Parathyroid hormone osteoporosis is indeed quite common in older female patients.