Parathyroid hormone test and benign lump

[WeeB]

I’ve had neck pain and light swelling for a few years along with many other difficult symptoms. I have hashimotos hypothyroid and i’m on levothyroxine and perimenopause and on HRT. Ent have just written to me to say they have found a benign lump on my thyroid on ultrasound and i’ve to go see them in two weeks. In the meantime, they have asked me to get a PTH blood test , is this standard for all thyroid lumps or does this suggest the lump is on the parathyroid gland? Also, does anyone know if they will do a biopsy or just take what see from ultrasound?

[PurpleNails Administrator]

PTH doesn’t tend to be tested very often & not as standard with neck lumps.  

When there’s been previous results showing high calcium it should be tested.

Do you have copies of previous results? 

When testing PTH it must usually be done on a site with lab facilities as sample has to be processed quickly. 

Some hospitals have it set up so during scan a decision can be made if fine needle aspiration is required.  Possibly if time allows. Others will say the scan has to be views by another & recommendations made on if FNA required.  

If they give you a choice, or say they don’t think you need one or imply it’s a more difficult area, I would push & say I want everything checked.  

Do you have any symptoms?

[WeeB in reply to PurpleNails]

Thanks for the reply. The consultant has asked the Gp to do the blood test prior to the consultants appointment so that won’t be done quickly. Looking back at previous blood tests , i only see one from sept 2022 where they have actually tested calcium levels. it was calcium 2.34 in a range of 2.20 to 2.60 and albumin 44 in range of 35-50.

Symptoms, some i’ve had a while , some are new the last two years and the rest have got significantly worse the last two years. i have hashimotos and vitamin deficiencies i treat , and perimenopausal so it’s near impossible to differentiate

- fatigue, shortness of breath, anxiety, neck and throat discomfort and pain, some mild swelling in neck/throat area, ankle and foot swelling, painful, weak, achy hands, planter fasciitis, general aches and pains , occasional nausea and light headedness, ear pressure and tinnitus, occasional pins and needles in face, hands and feet, general stiffness, eye pain and deterioration of eye sight in one eye . All the head issues are on right side of neck and head and i’ve seen neurologist who discounted nerve issues and is treating it like migraine with propanolol.

[waveylines in reply to WeeB]

Oh poor you. That sounds tough.So. Propranolol will lower the thyroid conversion rate of T4 ( thyroid storage hormone) to T3 ( use able form of thyroid hormone). So to be honest it's not a good idea to mix this with Hashi. Maybe adding to your woes. I'd point this out to neurologist and ask for alternative.

I'm no expert on parathyroid but if your GP has been asked to do this test by your specialist then you will have to let it roll.

And equally you will have to wait to see what endocrinologist says. Make sure you make them aware of the propranolol treatment. What dose did the neurologist give you?

[WeeB in reply to waveylines]

i’m on 40mg at the moment , but i’m reluctant to change to a different one as the one the neurologist suggested changing too had common side effects of anxiety and my anxiety is already difficult to cope with.

but i have a gp appointment soon and plan to push to get more detailed thyroid blood test than just their tsh test they do because i’m concerned propanolol is doing something to the t3 levels now i have been on it for 3 months.

[Hedgeree]

Hi WeeB,

Do you have any recent results (and their ranges ) for ferritin or vitamin D?

I know when my levels are very low in these I get lots of symptoms, breathlessness and shortness of breath, tiredness, headaches and sore and weak arm muscles. Generally very achy.

Best wishes.

[WeeB]

nothing recent for vitamin d because gp has me on vitamin d daily and doesn’t see the need . but i’ve got so bad this year so have a gp appointment to ask and make my case for detailed bloods on vitamins and thyroid 🤞 .

[Hedgeree in reply to WeeB]

That's a good plan.

[SmallBlueThing]

Do you also have high blood pressure? That can be as a result of having a parathyroid adenoma sending serum calcium high, although yours was in range, fairly recently. PTH tests aren't cheap, nor usually necessary, and I did read a few years ago that their unnecessary use was being discouraged, so I would've thought you would've had a bone profile test (for calcium and phosphate) more recently.

I thought I might have to have an FNA, but my ultrasound was at a local hospital (which was a lot more convenient) and where that procedure isn't performed. I really had to push for a PTH test, which was also done locally.

I didn't get on at all well with a beta blocker (atenolol) -- it affected my breathing when sleeping, making me even more fatigued.

Best wishes for a swift resolution.

[WeeB in reply to SmallBlueThing]

Thanks for the info . and yes my blood pressure has been a bit high for the last two years

[birkie in reply to WeeB]

Also can I just add, your calcium does not have to be out of range to have a parathyroid problem, a calcium in range and a PTH out of range is known as normocalcemic hyperparathyroidism, this in its self can still cause awful symptoms and still cause a parathyroid to become overactive.The parathyroid surgeon I spoke to told me his first patient with a normal calcium but slightly over range PTH couldn't be having symptoms to the degree she was, and he was very reluctant to do the operation on her (she went private with this surgeon nhs wouldn't touch her) to his amazement he found the offending parathyroid gland and removed it, she recovered well all her pain, fatigue ect went, she returned to work and the gym she couldn't thank him enough for going ahead with the op, although it took him to do her actual op before he believed you can have a normal calcium, and it's not all about the levels 👍

[WeeB in reply to birkie]

Thanks for this , good to know . I now have tonnes of questions for the consultant. Hope he is open to them.

[birkie]

Hi WeeB❤️

I had full thyroidectomy in 2019, personally I haven't felt very well on thyroid meds but in 2020 my parathyroid hormone and calcium went out of range and 2 endocrinologists told me I probably have primary hyperparathyroidism 🤦‍♀️ but after one normal blood test they are holding me to watch and wait.

The symptoms I'm getting are constant trips to the toilet to wee especially through night, very thirsty, heart palpitations (heart thumping) insomnia, bad bone pain in arms, legs, vibrations in lower legs, sweating profusely, shaking like I have low blood sugar (I don't) total fatigue, headaches, feeling sick, reduced appetite just feel so unwell 😣 nhs wouldn't do an ultrasound scan so my son paid for me to see a private parathyroid surgeon who as identified a 7mm nodule in my neck, going to see an endocrinologist in Liverpool for hopefully a pet chloride scan.

Did you have any calcium blood work done? For a full parathyroid test you should have PTH, calcium, vitamin D in one draw with the PTH being done in an EDTA tube normally with a purple top, then magnesium, phosphate should be tested also.

We have 4 parathyroid glands, one or more can become overactive also we can have thyroid nodules, it's reassuring your team are testing your parathyroid as its usually missed or they may have seen an over range calcium prompting the parathyroid test be interesting to see what your blood tests were if you have them👍

[WeeB in reply to birkie]

Sorry to hear what you’ve been going through. Hopefully you’re on your way to the right treatment now. I don’t have any blood tests apart from one for calcium september last year and that was in the normal range .