Feet First

“It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” - Sir William Osler

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    Thursday, August 26, 2004
    Good Catch

    ... if I do say so myself.

    Hyperparathyroidism is a subtle disease. Once or twice, I've missed early signs of it and the patients were not diagnosed until they became overtly symptomatic. (Yes! I admit it!) It's caused by overactivity of the parathyroid glands - as you might guess from the name, they are located in the neck near the thyroid. There are four of them, two bracketing the thyroid gland on each side. Their function is to control the calcium and phosphorus balance in the body. Parathyroid hormone pulls calcium from the bones and raises the calcium level in the bloodstream.

    So a patient who needed minor surgery on her finger came in for a pre-op exam and labs. Her calcium level came back slightly high. I looked back a few years in her chart - it had been creeping up over the last few years. Ionized calcium - elevated. Parathyroid hormone level - over 140! Definitely high. She's off to see the surgeon; hyperparathyroidism is treated by removing the glands.

    It isn't often that you see this disease in general practice, but it does crop up every once in awhile. Earlier this year I had a patient who died of it. (Disclaimer: he was 102 years old and the family and I elected not to put him through extensive neck surgery he'd never survive. We put him on hospice instead.)

    Just goes to show: you never know what you might pick up on a preop exam.



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