The best way to diagnose parathyroid disease and the process In the previous article, I suggested that parathyroidism should no longer be overlooked. For most people, parathyroid is still an unfamiliar term, but hyperparathyroidism can lead to consequences that can be very serious and have an insidious onset, with some patients experiencing a decade of misdiagnosis and missed diagnoses, resulting in irreparable damage. In terms of the type of disease, parathyroid disorders are actually relatively simple. The common ones are parathyroid hyperplasia, adenomas and cysts, and occasionally rare cases of adenocarcinoma, all of which can lead to hyperparathyroidism. How can we quickly detect and determine if we have hyperparathyroidism? Based on my own research experience over the years, I would like to introduce here the best diagnostic methods and diagnostic process of hyperparathyroidism for patients who need to take less detours. I. Diagnostic methods of hyperparathyroidism 1. Functional status measurement: hyperfunction means that the level of parathyroid hormone in the patient’s blood exceeds the upper limit of the normal range and leads to an increase in the concentration of calcium ions and a decrease in the concentration of phosphorus ions in the blood, so the detection of blood calcium (Ca) and phosphorus (P) concentrations as well as parathyroid hormone (PTH) levels is a decisive measure for the diagnosis of hyperparathyroidism. Calcium and phosphorus tests are widely available and can be measured at a level II hospital, and the results are known within a few hours. Parathyroid hormone radioimmunoassay requires a tertiary care hospital and results are available in about three days. In most cases, parathyroid hyperplasia or adenoma is functional, and patients with elevated serum parathyroid hormone levels are accompanied by varying degrees of elevated calcium. In the author’s opinion, in today’s world where health checkups (commonly referred to as “physical examinations”) are quite popular, adding parathyroid hormone, calcium and phosphorus tests to blood tests is valuable for the early detection of hyperparathyroidism and the protection of the patient’s health, and the procedure is very simple and does not add any pain to the patient. However, there are rare cases of non-functioning parathyroid adenomas or hyperplasia, which do not cause an increase in serum parathyroid hormone, and such cases require high-frequency ultrasonography. High frequency ultrasonography: 95% of the parathyroid glands are located near the thyroid gland, so high frequency ultrasonography of the neck has unique diagnostic value for the parathyroid glands, and its advantage over X-ray CT and MRI is mainly due to the superior spatial resolution of high frequency ultrasonography, which can detect tiny lesions of about 2mm. In recent years, high-frequency ultrasound technology has developed rapidly, and color Doppler high-frequency ultrasound, three-dimensional high-frequency ultrasound, contrast high-frequency ultrasound, and elastic high-frequency ultrasound have emerged one after another, which are unmatched for in-depth understanding of pathological anatomical information such as parathyroid adenomas, hyperplasia, and cysts. However, about 3% of parathyroid glands can live ex situ, growing in the mediastinal cavity and are closely related to the thymus (the “ancestors” of the two are close relatives). In rare cases, the parathyroid glands can grow in the pericardium, stomach wall, bladder wall and other “unrelated” places, so the diagnostic value of ultrasonography is greatly reduced and nuclear medicine imaging is needed. 3.Tc-99 nuclide examination (MIBI): thyroid and parathyroid gland have high affinity for the isotope technetium-99. After the injection of technetium-99-containing contrast agent into the thyroid and parathyroid glands, both thyroid and parathyroid glands take up more contrast agent, and usually reach the maximum level of contrast in 15 minutes, after which the contrast agent will gradually withdraw from the parathyroid and thyroid glands, usually in 120-150 minutes, and the images of thyroid and parathyroid glands disappear. However, the developer in parathyroid hyperplasia and adenoma can remain for a long time, with more developer remaining in the diseased gland by 120-150 minutes, when the normal glandular tissue image disappears, resulting in a very striking nuclear image of the lesion. This characteristic of parathyroid adenomas and hyperplasia can be exploited to detect parathyroid hyperplasia or adenomas in the neck or mediastinum by performing duplex technetium-99 nuclear imaging (imaging of the neck and chest at the 15th and 150th minutes after the intravenous injection of technetium-99, respectively). The only drawback is the radioactive toxicity of the isotope, which makes it inappropriate to use it frequently. However, a small number of negative parathyroid adenomas or hyperplastic nuclear examinations have been found, or even one out of three to four hyperplastic glands in the same patient was negative, while the remaining hyperplastic parathyroid glands were positive, and the mechanism leading to this phenomenon needs to be further investigated. Given the limited value of ultrasonography for ectopic parathyroid glands in the mediastinum, technetium-99 nuclide examination is particularly suitable for the examination and diagnosis of ectopic parathyroid lesions in the mediastinum. Therefore, when hyperparathyroidism is highly suspected and high-frequency ultrasound of the neck does not reveal a problem, one must remain vigilant for ectopic parathyroid glands in the mediastinum and actively seek technetium-99 nuclide examination. For parathyroid lesions growing in the pericardium, stomach wall, bladder wall, etc., PET-CT should be sought, but its diagnostic specificity is not strong. 2. Diagnostic process of hyperparathyroidism 1. Primary hyperparathyroidism: (1) In the first case, when abnormalities such as kidney and ureteral stones of unknown cause are found on abdominal ultrasound, CT and other imaging examinations, high-frequency ultrasound examination of the neck should be actively applied. If suspicious parathyroid adenoma or hyperplasia is found in the anatomical region of the parathyroid glands on high-frequency ultrasound examination of the neck, then serum parathyroid hormone, serum calcium and phosphorus determination. (2) In the second scenario, when patients present with overly prone fractures, actively apply for serum parathyroid hormone and serum calcium and phosphorus assays, and if abnormalities are present, apply for high-frequency ultrasound of the neck, and if no abnormalities are found on ultrasound, actively apply for technetium-99 nuclear examinations of the neck and chest. (3) In the third scenario, individual patients first show mental laziness, drowsiness, dry mouth and easy thirst, dyspepsia, etc., which also lack specific manifestations. In case of such manifestations, it is worthwhile to be more alert and should actively apply for high-frequency ultrasound of the neck and determination of parathyroid hormone. It is worth pointing out that parathyroid adenomas were previously thought to involve more than one gland, but I have found that parathyroid adenomas can be multiple at the same time or multiple at different times. Some patients may have parathyroid adenomas twice or even three times, with intervals of several to ten years. It is important to be wary of such patients, lest you think that because the patient has undergone parathyroid adenoma surgery earlier, it will not recur. From the domestic situation, primary hyperparathyroidism due to parathyroid adenoma or hyperplasia is very insidious, lacking specificity in clinical presentation, and easily missed or misdiagnosed. With enhanced high frequency ultrasound examination of the neck and serum parathyroid hormone testing, diagnosis becomes very easy and fast. In terms of the hospital consultation process, primary hyperparathyroidism is usually classified under endocrinology and neck surgery, but if the disease is not thought of in time at the outpatient clinics of the two aforementioned departments, misdiagnosis or underdiagnosis is inevitable. The author’s suggestion is that, in addition to the endocrinology and head and neck surgery departments, if you suspect this disease, you should go to the corresponding specialist clinic of the ultrasound department as a matter of priority, because the ultrasonographer has the priority facility to examine the ultrasound equipment and can clarify whether there is a problem with the parathyroid glands in the neck in the first place. 2. Secondary hyperparathyroidism: Most patients with this type of disease are on maintenance hemodialysis for uremia, and the underlying disease has strong suggestive signals. According to the author’s statistics, about 85% to 90% of patients who have been on hemodialysis for more than 3 years develop secondary hyperparathyroidism. As hemodialysis continues, the condition gradually worsens, causing a series of serious hazards in the form of bone decalcification, shortening, fracture, ectopic calcification, skin pruritus, calcification of the lens of the eye, and deformation of the body. For uremic hemodialysis patients, the author strongly recommends that you should undergo serum parathyroid hormone measurement and neck parathyroid ultrasound examination as early as possible for early detection and treatment, because once the disease has progressed to the stage of serious harm mentioned above, it is difficult to reverse many problems even if treatment is implemented. Early detection allows early treatment, and early treatment can at least slow down the emergence and development of related hazards. Triple hyperparathyroidism: This type of patient is very rare, but their presence reminds those who have undergone kidney transplantation not to take it lightly, but to keep an eye on whether their original secondary hyperparathyroidism has really disappeared. Screening is still done by performing high frequency ultrasound, ultrasound of the transplanted kidney and serum parathyroid hormone measurement. If enlarged parathyroid glands are still found, they should be treated quickly so that your precious transplanted kidney is not damaged by stones. Third, who needs to be alert to possible hyperparathyroidism Based on the author’s experience and reports from other researchers, the following groups of people need to maintain a certain degree of vigilance and apply for the above-mentioned tests in a timely manner in order to detect or exclude hyperparathyroidism in a timely manner. 1. people on hemodialysis for uremia 2. people with age-inappropriate osteoporosis 3. people with kidney stones, especially bilateral kidney stones 4. people with fractures without more serious external force 5. people with loss of appetite, increasing weight loss, bloating and dyspepsia 6. people with inexplicable thirst, increased water intake, mental laziness and drowsiness 7. people with frequent knee pain, lower limb weakness, or back pain 8.Patients who have suffered from adrenal pheochromocytoma or medullary thyroid cancer 9.Patients who have suffered from parathyroid adenoma or hyperplasia