Case Study: The Thyroid Tango Entangled with PTH
Patient: 52-year-old woman with a 6-month history of weight loss, anxiety, palpitations, and muscle weakness.
Initial presentation:
- Symptoms suggestive of hyperthyroidism
- Physical examination: tachycardia, tremor, exophthalmos (bulging eyes)
- Laboratory findings:
- Elevated T4 and T3 levels (confirming hyperthyroidism)
- Slightly elevated calcium
- PTH within the “normal” range
Diagnostic Dilemma:
- Hypercalcemia raised suspicion for coexisting hyperparathyroidism.
- “Normal” PTH was challenging, considering normocalcemic hyperparathyroidism possibility.
Further Investigation:
- Advanced PTH assay revealed elevated bioactivity despite normal total PTH.
- Bone scan showed increased bone turnover consistent with PTH-mediated resorption.
- Parathyroid scintigraphy identified a single enlarged parathyroid gland.
Diagnosis:
- Hyperthyroidism due to Graves’ disease (confirmed by specific thyroid antibody tests)
- Coexisting normocalcemic primary hyperparathyroidism
Treatment:
- Antithyroid medication for Graves’ disease
- Minimally invasive parathyroid surgery to remove the enlarged gland
Outcome:
- Improvement in all hyperthyroid symptoms within months.
- Stabilization of calcium levels and bone density.
- Improved quality of life and long-term management of both conditions.
Key Takeaways:
- This case exemplifies the diagnostic challenge posed by PTH’s subtle interference in hyperthyroidism.
- The importance of advanced PTH assays, bone markers, and imaging in unveiling normocalcemic hyperparathyroidism.
- Timely diagnosis and targeted treatment for both thyroid and parathyroid conditions can lead to successful management and improved patient outcomes.
Note: This case study is intended for educational purposes only and should not be interpreted as medical advice. Always consult with a qualified healthcare professional for diagnosis and treatment of any medical condition.