Endocrine Abstracts (2013) 32 P171 | DOI: 10.1530/endoabs.32.P171

Could PHPT be diagnosed at early stages even more frequently?

Helena Šiprová1, Kvetoslav Šipr2 & Zdenek Fryšák3

12nd Department of Internal Medicine, St Anne’s University Hospital Brno, Brno, Czech Republic; 2Department of Social Medicine and Health Policy, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic; 3Department of Internal Medicine III, Nephrology, Rheumatology and Endocrinology, Faculty of Medicine and Dentistry, Palacky University Olomouc, Olomouc, Czech Republic.

Primary hyperthyroidism (PHPT) is one of the diseases which are usually diagnosed in asymptomatic period nowadays. Even though considerable success was achieved, in some cases PHPT is not found out before complications were developed. A prospective study focuses on diagnostics and therapy of PHPT has been in progress at two tertiary centers of endocrinology in the Czech Republic since January 1st, 2007, with early diagnosis of PHPT being one of its aims. In a 6-year period, there were 217 patients with PHPT. There were 29 hypercalcemic patients. Their serum calcium level exceeded 2.60 mmol/l. 188 normocalcemic patients had serum calcium level 2.60 mmol/l or less at the first examination. Intermittent or constant hypercalcemia developed in 28 patients who were originally normocalcemic. Four years was the longest period during which constant hypercalcemia developed in an originally normocalcemic patients. Set of symptoms being characteristic of PHPT was present only in ten patients when they were included into the study group, later on some clinical features appeared in other 14 patients. The most common complaints were fatigue, gastrointestinal signs, muscular and bone pain and psychiatric problems, especially depression. There was stated a frequent coincidence of PHPT and disorders of pituitary gland. Therefore it was started with parathyroid hormone serum level examination of patients treated at the centre of endocrinology in the time of study. Normocalcemic PHPT was found out at 107 endocrine patients.

Conclusions: Serum parathyroid hormone level examination in asymptomatic patients seems to be the most important tool of PHPT early detection. A frequent coincidence of PHPT and other endocrine disorders was found out, this finding needs to be verified. Permanent hypercalcemia can be developed in a normocalcemic patient with PHPT even after a 4-year period.

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