Hyperparathyroidism Support Group
Hyperparathyroidism is overactivity of the parathyroid glands resulting in excess production of parathyroid hormone (PTH). Increased PTH consequently leads to increased serum calcium (hypercalcemia) due to 1) increased bone resorption, allowing flow of calcium from bone to blood, 2) reduces renal clearance of calcium, and 3) increases intestinal calcium absorption.
Greetings,
I had the DEXA and Sestamibi scans performed. The DEXA was a -1.80 on one reading and a -1.60 on another. This is an improvement over the -2.0 a had a few years ago, but I think that is due to the more thorough nature of the current scan.
The Sestamibi scan results were uncertain (big surprise). I will show them below for any who care. I will use ALL CAPS for emphasis:
FINDINGS:
The multiple planar sestamibi images demonstrate no convincing
retention of radiotracer in the thyroid bed.
Asymmetrical increased uptake adjacent to the left submandibular
gland, LIKELY within normal limits. An ectopic undescended
parathyroid adenoma in the same region is NOT excluded.
The SPECT sestamibi images corroborate with planar images. No
significant abnormalities in the remainder of the study.
IMPRESSION:
1. No scintigraphic findings to suggest parathyroid adenoma in the
thyroid bed region.
2. Asymmetrical increased uptake anterior and adjacent to the left
submandibular gland COULD be within normal limits OR REPRESENT ANECTOPTIC PRARTHYROID ADENOMA. Suggest MR of the neck for further characterization.
So, there you go. Still uncertain.
Regards, Brenden.
I had the DEXA and Sestamibi scans performed. The DEXA was a -1.80 on one reading and a -1.60 on another. This is an improvement over the -2.0 a had a few years ago, but I think that is due to the more thorough nature of the current scan.
The Sestamibi scan results were uncertain (big surprise). I will show them below for any who care. I will use ALL CAPS for emphasis:
FINDINGS:
The multiple planar sestamibi images demonstrate no convincing
retention of radiotracer in the thyroid bed.
Asymmetrical increased uptake adjacent to the left submandibular
gland, LIKELY within normal limits. An ectopic undescended
parathyroid adenoma in the same region is NOT excluded.
The SPECT sestamibi images corroborate with planar images. No
significant abnormalities in the remainder of the study.
IMPRESSION:
1. No scintigraphic findings to suggest parathyroid adenoma in the
thyroid bed region.
2. Asymmetrical increased uptake anterior and adjacent to the left
submandibular gland COULD be within normal limits OR REPRESENT ANECTOPTIC PRARTHYROID ADENOMA. Suggest MR of the neck for further characterization.
So, there you go. Still uncertain.
Regards, Brenden.
So--no adenoma in the usual places, as far as the radiologist can see. There is something unusual going on near your left submandibular gland, which could indicate a PTH adenoma up there in an ectopic (meaning unusual) location. But the radiologist did not want to commit to that, because it isn't that unusual for those glands to handle the tracing chemicals differently, left to right.
If you search "ectopic submandibular parathyroid adenoma" you'll be directed to articles such as this one:
http://www.snm.org.tw/revista2005/200507/pdf/v14n1/AnnNuclMedSci01-14-51.pdf
or this one:
http://www.ncbi.nlm.nih.gov/pubmed/14609869
You might want to check to be sure you had the correct kind of MIBI scan and that the radiologist looked very closely at the suggested angles to see what was going on.
Overall, my quick look at the articles indicated that if you have a PTH adenoma that's in an ectopic (unusual) location, radio-guided surgery is the way to go, so that the surgeon won't have to go poking around all over your neck.
Anyway, those are my thoughts. I'm glad you are moving forward.
Regarding the DEXA scan, the difference could be a difference in scans, or conclusions of the physician. My pre-surgery scan was very bad, my post-surgery scan hugely improved. My endo said "hey, great recovery" but a GP who focuses a lot on women's health took a look and said that some of what looked like an increase in bone density might actually be arthritis. So not quite such a fantastic recovery.....
I guess if I were in your situation, I'd keep reminding my docs that this diagnosis is supposed to be made on the basis of blood chemistry and how you feel. Your Ca and PTH levels are unusual, if not strictly out of normal range all the time, and you feel crappy. So they ought to set about finding a way to localize that tumor and get it out of there!