The parathyroid glands should no longer be ignored. For most people, parathyroid is still an unfamiliar term, but the consequences of hyperparathyroidism can be very serious, and the onset of the disease is insidious, with some patients experiencing more than a decade of misdiagnosis and underdiagnosis, resulting in irreparable damage. Parathyroid disorders are relatively simple in terms of the type of disease, with common parathyroid hyperplasia, adenomas and cysts, and the occasional rare case of adenocarcinoma, all of which can lead to hyperparathyroidism. How to quickly detect and determine if you have hyperparathyroidism? Based on my years of research, I would like to introduce the best diagnostic methods and diagnostic process of hyperparathyroidism for the reference of patients who need to take a detour. I. Diagnostic methods for 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. Therefore, the detection of blood calcium (Ca), phosphorus (P) concentration and the level of parathyroid hormone (PTH) is the decisive measure for diagnosis of hyperparathyroidism. Calcium and phosphorus tests are widely available and can be measured in secondary care hospitals, and the results are known within a few hours. Parathyroid hormone radioimmunoassay is performed in a tertiary care hospital and the results are available in about three days. In the vast majority of cases, parathyroid hyperplasia or adenoma is functional, and the patient’s serum parathyroid hormone level is elevated, accompanied by varying degrees of elevated blood calcium. In the author’s opinion, nowadays, when health checkups (i.e. physical examination) are quite popular, it is very valuable to add parathyroid hormone, calcium and phosphorus tests to the blood test program for early detection of hyperparathyroidism and protection of patients’ health, and the process is very simple and does not add any pain to the patients. However, there are rare parathyroid adenomas or hyperplasia that are nonfunctional, i.e., they do not cause an increase in serum parathyroid hormone, and such cases require high-frequency ultrasonography. 2, high-frequency ultrasound: 95% of parathyroid glands are located in the vicinity of the thyroid gland, therefore, high-frequency ultrasound of the neck has a unique diagnostic value for parathyroid glands, and its advantage over X-ray CT and magnetic resonance imaging, mainly because of the high-frequency ultrasound’s superior spatial resolution, which is capable of detecting tiny lesions of about 2mm. In recent years, the development of high-frequency ultrasound technology has been rapid, with the emergence of color Doppler high-frequency ultrasound, three-dimensional high-frequency ultrasound, contrast high-frequency ultrasound, elastic high-frequency ultrasound, etc., which is unparalleled for in-depth understanding of the pathological and anatomical information of parathyroid adenomas, hyperplasia, cysts, and so on. However, about 3% of parathyroid glands are ectopic, growing in the mediastinal cavity, and are closely related to the thymus (the “ancestors” of both are close relatives). There are also rare cases, parathyroid glands can grow in the pericardium, stomach wall, bladder wall and other “eight rod can not hit” place, at this time, the diagnostic value of ultrasound greatly reduced, need to resort to nuclear medicine imaging examination. 3, technetium-99 nuclide examination (MIBI): the thyroid and parathyroid glands have a high affinity for the isotope technetium-99. After injecting technetium-99-containing contrast agent intravenously, the thyroid and parathyroid glands take up more contrast agent, usually reaching the maximum degree of development in 15 minutes, after which the contrast agent will gradually withdraw from the parathyroid glands and thyroid gland, usually in 120~150 minutes when the basic withdrawal of the net, the image of the thyroid gland and parathyroid glands disappears. However, the contrast agent in parathyroid hyperplasia and adenoma can stay for a long time, and at 120~150 minutes there is still more contrast agent remaining in the diseased glands, and at this time the normal image of the gland tissues disappears, resulting in a very eye-catching nuclear image of the lesion. Taking advantage of this characteristic of parathyroid adenomas and hyperplasias, dual-time-phase technetium-99 nucleotide videography (imaging of the neck and chest at 15 and 150 minutes, respectively, after intravenous injection of technetium-99) can detect parathyroid hyperplasia or adenomas in the neck or in the mediastinum. This method has high sensitivity and specificity, with the only drawback being the radioactive side effects of the isotope, which makes it inadvisable for frequent use. However, a small number of parathyroid adenomas or hyperplasias have been found to be negative on nuclear examination, or even one out of three to four hyperplastic glands in the same patient is negative while the remaining hyperplastic parathyroid glands are positive, and the mechanism leading to this phenomenon needs to be further explored. Given the limited value of ultrasonography for ectopic parathyroid glands in the mediastinum, technetium-99 nuclear examination is particularly suitable for the detection and diagnosis of mediastinal ectopic parathyroid lesions. Therefore, when hyperparathyroidism is highly suspected and high-frequency ultrasound of the neck does not reveal a problem, it is important to remain vigilant for ectopic parathyroid glands in the mediastinum and to proactively seek technetium-99 nuclide testing. For parathyroid lesions growing in the pericardium, stomach wall, bladder wall, etc., PET-CT should be sought, but its diagnostic specificity is not strong. Second, the diagnostic process of hyperparathyroidism 1, primary hyperparathyroidism: (1) the first situation, when abdominal ultrasound, CT and other imaging tests found that the cause of the kidney, ureteral stones and other abnormalities, you should actively apply for high-frequency ultrasound examination of the neck, high-frequency ultrasound examination of the neck, such as in the anatomical region of the parathyroid glands found in the suspected parathyroid adenomas or hyperplasia, you should actively apply for serum parathyroid hormone, serum calcium and phosphorus measurements. (2) In the second scenario, when a patient presents with an overly prone fracture, serum parathyroid hormone and serum calcium and phosphorus should be aggressively requested, as well as high-frequency ultrasound of the neck if abnormal, and technetium-99 nucleotide testing of the neck and chest if the ultrasound does not reveal any abnormalities. (3) In the third scenario, individual patients first show mental laziness, drowsiness, dry mouth and easy thirst, dyspepsia, etc., which also lacks specific manifestations. When encountering this kind of manifestation, it may be worthwhile to be more alert, and should actively apply for high-frequency ultrasound of the neck and parathyroid hormone measurements. It is worth pointing out that parathyroid adenomas are thought to involve one gland, but the author found that parathyroid adenomas can be multiple at the same time or multiple at different times. In some patients, parathyroid adenomas can occur twice or even three times, with intervals of several to ten years. It is important to be vigilant in these patients so as not to assume that because the patient has been operated on earlier for parathyroid adenomas, there will be no recurrence. Domestically, primary hyperparathyroidism due to parathyroid adenoma or hyperplasia is very insidious, lacks specificity in clinical manifestations, and is easily missed or misdiagnosed, and can be easily and quickly diagnosed with enhanced high-frequency ultrasonography of the neck and serum parathyroid hormone testing. In terms of the hospital consultation process, primary hyperparathyroidism is usually categorized under the Department of Endocrinology and the Department of Neck Surgery, but if the disease is not thought of in a timely manner in the outpatient clinics of the two departments mentioned above, misdiagnosis or omission of the diagnosis is unavoidable. The author’s suggestion is that, in addition to endocrinology and head and neck surgery, the author should give priority to ultrasonography to the corresponding specialist clinic. Ultrasonographers have the priority of ultrasonography equipment, which can clarify whether there is a problem with the parathyroid glands in the neck at the first time. 2, secondary hyperparathyroidism: most of the patients with this type of uremia line maintenance hemodialysis, the underlying disease has a strong signal. According to the author’s statistics, about 85%~90% of patients who have been on hemodialysis for more than 3 years have secondary hyperparathyroidism. With the continuation of hemodialysis, the condition gradually aggravates, causing a series of serious harms such as bone decalcification, shortening, fracture, ectopic calcification, itchy skin, calcification of the lens of the eye, and deformation of the human body. For uremic hemodialysis patients, the author strongly suggests that you should carry out serum parathyroid hormone measurement and ultrasound examination of parathyroid glands in the neck as early as possible for early detection and treatment, because once it develops to the stage of the above mentioned serious harms, it is difficult to reverse many of the problems even with the implementation of treatment. Early detection allows for early treatment, and early treatment can at least slow down the emergence and progression of the associated harm. 3, triple hyperparathyroidism: this type of patients are very rare, but their existence reminds those who have undergone kidney transplantation should not be taken lightly, or should continue to pay attention to their original secondary hyperparathyroidism is really gone. The method of checking is still to carry out high-frequency ultrasonography, ultrasonography of the transplanted kidney and measurement of serum parathyroid hormone, and once it is found that there is still an enlarged parathyroid gland, then it should be treated quickly so as to prevent your valuable transplanted kidney from being damaged by the stones. Who should be alert to the possibility of hyperparathyroidism According to the author’s experience and the reports of other researchers, the following groups of people need to maintain a certain degree of vigilance and apply for the above tests in a timely manner, with a view to timely detection or exclusion of hyperparathyroidism. 1, uremic hemodialysis population 2, age-inappropriate osteoporosis population 3, kidney stones, especially bilateral kidney stones 4, people who suffer from bone fracture without being subjected to more serious external force 5, loss of appetite, wasting, abdominal distension, indigestion, etc. gradually aggravated 6, inexplicable thirst, increased water intake, mental laziness, lethargy 7, knee pain, lower limb weakness, or back pain 8, people who have ever had hyperparathyroidism. or back pain. 8. Patients who have suffered from adrenal pheochromocytoma or medullary carcinoma of the thyroid gland. 9. Patients who have suffered from adenoma or hyperplasia of the parathyroid glands.