Case Study: The Thyroid Tango Entangled with PTH

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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.

Hypoparathyroidism: 

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