Sign-in to Ask A Doctor - 24x7
OR
Sign in with Google
What Do My Ultrasound And Blood Test Reports Indicate?
Question: Re Hashimotos vs thyroid cancer.
Ultrasound, bloodwork as follows:
37y/o female hx of +ANA Hx of Hypercalcemia for several years fluctuating between 9.9 when "normal range, (Normal for reporting lab@ cutoff of 10.2) to 11.8 when high. Serum calcium never goes below 9.9 when normal, never above 11.8 when high.
TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
Thyroglobulin, Antibody 347.4 HIGH IU/mL
Antithyroglobulin antibodies measured by Beckman Coulter Methodology
(0.0-0.9 01 Ref Range for this reporting lab).
Thyroid Peroxidase (TPO) Ab 38 HIGH (IU/mL 0-34 Reference Range for this reporting lab).
Calcium, Serum 10.8 (8.7-10.2 Reference Range for this reporting lab).
PTH, Intact 28 (15-65 Reference Range for this reporting lab).
Exam:US Thyroid Date of Exam 1/05/14 Sonographic Findings: Right Lobe: Nodules are present. The largest being Heterogenous. Size=0.50x0.45x0.20cm
Left Lobe: Single Nodule Identified . Size=0.40x0.30x0.20
Isthmus=Normal thickness:0mm
Parathyroids: Left Inferior area measured Lymph node vs parathyroid.
Measuring=0.7x0.5x0.4cm
Size:Thyroid-Right Lobe.
Length 4.7cm width 1.6 cm Depth 1.1cm Volume 4.2cc
Size: Thyroid-Left Lobe.
Length 4.6cm Width 1.3cm Depth 1.2cm Volume:3.8cc
Summary: Impression:1. Subcentimeter thyroid nodules as described. This will serve as a baseline for future examinations. 2. Subcentimeter hypoechic nodule at the inferior margin of the left thyroid lobe, which may represent a parathyroid gland versus a lymph node. Attention on follow-up is recommended.
Sxs as follows: Cough on and off for last 3 months. Sucks on cough drops (4-6 a day) everyday. Feels throat is getting tighter. Visible bulging on right side of neck and over thyroid at current and other people do notice as well. Thoracic pn scale of 8 at times on pn scale 1-10. EXTREME neck pn 10 at times. Previous hx of cervical stenosis and 2 acdf procedures. During times of hypercalcemia hears an audible grinding and clicking when turning head. Left leg shin bone pain..pain across all toes of left leg and sometimes greatest at big toe. Flank (kidney pain on both sides but worse on left at times). Chest pain extreme at times..ekg clean. Extreme dizziness and brain fog, forgetfulness. Mononeuritis Multiplex which has turned to polyneuropathy multiplex dx'd via EMG/NCV. Tightness in throat worse at times and sometimes feels as though something stuck inside throat makes it difficult to swallow and breathe many times during swelling several times a week. Hot flashes, fidgetiness, hard to sleep sometimes, constantly tired and sleeping others. Snapping cracking very audibly loud@right Jaw on opening. Wondering if Hashimotos VS Thyroid cancer and if PTHrp test would be helpful. Also, would like to know if would recommend repeating ultrasound again to correlate with increased swelling, swallowing breathing problems, etc. Thank you and God bless.
sorry, forgot to mention Vitamin D is LOW by about half on readouts consistently
follow up to follow up if I may: Severe dizziness at times out of the blue, feels like blowing up a thousand balloons fast and suffering that dizziness thereafter. Shift in teeth spaces; extremely worried about bone loss..would like recommendations on which testing I should go for considering hypercalcemia..Side note: I have read some peer reviewed journals wherein doctors have described a concomitant thyroiditis Hashimotos along with that of a "hidden" parathyroid problem (parathyroid adenoma which reflects in the pts hypercalcemia yet when pth is low as is in mine it is due to a "Hook" effect???? Thank you once again and God bless the answering doctor and peer reviewing doctor! :-)
Ultrasound, bloodwork as follows:
37y/o female hx of +ANA Hx of Hypercalcemia for several years fluctuating between 9.9 when "normal range, (Normal for reporting lab@ cutoff of 10.2) to 11.8 when high. Serum calcium never goes below 9.9 when normal, never above 11.8 when high.
TESTS RESULT FLAG UNITS REFERENCE INTERVAL LAB
Thyroglobulin, Antibody 347.4 HIGH IU/mL
Antithyroglobulin antibodies measured by Beckman Coulter Methodology
(0.0-0.9 01 Ref Range for this reporting lab).
Thyroid Peroxidase (TPO) Ab 38 HIGH (IU/mL 0-34 Reference Range for this reporting lab).
Calcium, Serum 10.8 (8.7-10.2 Reference Range for this reporting lab).
PTH, Intact 28 (15-65 Reference Range for this reporting lab).
Exam:US Thyroid Date of Exam 1/05/14 Sonographic Findings: Right Lobe: Nodules are present. The largest being Heterogenous. Size=0.50x0.45x0.20cm
Left Lobe: Single Nodule Identified . Size=0.40x0.30x0.20
Isthmus=Normal thickness:0mm
Parathyroids: Left Inferior area measured Lymph node vs parathyroid.
Measuring=0.7x0.5x0.4cm
Size:Thyroid-Right Lobe.
Length 4.7cm width 1.6 cm Depth 1.1cm Volume 4.2cc
Size: Thyroid-Left Lobe.
Length 4.6cm Width 1.3cm Depth 1.2cm Volume:3.8cc
Summary: Impression:1. Subcentimeter thyroid nodules as described. This will serve as a baseline for future examinations. 2. Subcentimeter hypoechic nodule at the inferior margin of the left thyroid lobe, which may represent a parathyroid gland versus a lymph node. Attention on follow-up is recommended.
Sxs as follows: Cough on and off for last 3 months. Sucks on cough drops (4-6 a day) everyday. Feels throat is getting tighter. Visible bulging on right side of neck and over thyroid at current and other people do notice as well. Thoracic pn scale of 8 at times on pn scale 1-10. EXTREME neck pn 10 at times. Previous hx of cervical stenosis and 2 acdf procedures. During times of hypercalcemia hears an audible grinding and clicking when turning head. Left leg shin bone pain..pain across all toes of left leg and sometimes greatest at big toe. Flank (kidney pain on both sides but worse on left at times). Chest pain extreme at times..ekg clean. Extreme dizziness and brain fog, forgetfulness. Mononeuritis Multiplex which has turned to polyneuropathy multiplex dx'd via EMG/NCV. Tightness in throat worse at times and sometimes feels as though something stuck inside throat makes it difficult to swallow and breathe many times during swelling several times a week. Hot flashes, fidgetiness, hard to sleep sometimes, constantly tired and sleeping others. Snapping cracking very audibly loud@right Jaw on opening. Wondering if Hashimotos VS Thyroid cancer and if PTHrp test would be helpful. Also, would like to know if would recommend repeating ultrasound again to correlate with increased swelling, swallowing breathing problems, etc. Thank you and God bless.
sorry, forgot to mention Vitamin D is LOW by about half on readouts consistently
follow up to follow up if I may: Severe dizziness at times out of the blue, feels like blowing up a thousand balloons fast and suffering that dizziness thereafter. Shift in teeth spaces; extremely worried about bone loss..would like recommendations on which testing I should go for considering hypercalcemia..Side note: I have read some peer reviewed journals wherein doctors have described a concomitant thyroiditis Hashimotos along with that of a "hidden" parathyroid problem (parathyroid adenoma which reflects in the pts hypercalcemia yet when pth is low as is in mine it is due to a "Hook" effect???? Thank you once again and God bless the answering doctor and peer reviewing doctor! :-)
Brief Answer:
Please see detailed answers
Detailed Answer:
Hi XXXX,
Welcome to HCM. Thanks for posting the detailed question. I understand your concerns. We have to sort out 3 problems. Thyroid, High calcium, your symptoms of dizziness, neck discomfort etc.
1. Thyroid
You are probably having Hashimoto's thyroiditis. Couldn't make out the thyroid function reports from your question. How is your T4 and TSH? If it is well within normal range, no treatment is needed for thyroid at present. In auto immune thyroid disease (Hashimoto's), there will be antibodies against thyroid which will try to destroy the thyroid by causing inflammation (swelling) and fibrosis (scarring). This results in decreased hormone production (hypothyroidism).
Initially when the destruction is partial the thyroid will be still producing hormone to have normal T4 and TSH. But the inflammation can symptoms like pain, heaviness, tightness etc in neck due to thyroiditis. Probably you are having all symptoms of thyroiditis now
The treatment of thyroiditis is supportive with analgesics like paracetamol. This will last for few months. In severe cases steroids are indicated.
From the ultrasound findings, thyroid carcinoma is very unlikely. The test we do to find out cancer is needle biopsy (FNAB/FNAC). This test is indicated when the nodule size is more than 1 cm or if there are smaller but suspicious nodules are there - which is not there in your case.
What I do in this situation is follow up thyroid function tests every 3-6 months, do a repeat ultrasound neck after 6-12 months.
2. Hypercalcaemia
High calcium need to evaluated and the tests need to be repeated. The tests that we do are:
1. Fasting calcium, phosphorus, albumin
2. Parathyroid hormone(PTH) - has to be taken in a good lab - collected in ice. If not collected properly, the results can be low.
3. Serum Alkaline phosphatase
4. 24 hour urine for calcium, phosphorus, creatinine
5. Hand X ray - to see any change of hyperparathyroidism
6. 25 hydroxy vitamin D - which is done - low in your case
In a similar situation, with whatever results you have shared with us, my suggestion will be to replace vitamin D and see if calcium is going up above the normal limits.
PTHrp is considered if PTH is low and Calcium is high and phosphorus is low. I think we can consider it as a second line investigations after ruling out hyperparathyroidism.
3. Symptoms
Thyroiditis and vitamin D deficiency may be responsible for some of your symptoms like neck pain and dizziness. I think we will replace vitamin D and wait for the symptoms of thyroiditis to settle by itself.
Wishing you good health.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Please see detailed answers
Detailed Answer:
Hi XXXX,
Welcome to HCM. Thanks for posting the detailed question. I understand your concerns. We have to sort out 3 problems. Thyroid, High calcium, your symptoms of dizziness, neck discomfort etc.
1. Thyroid
You are probably having Hashimoto's thyroiditis. Couldn't make out the thyroid function reports from your question. How is your T4 and TSH? If it is well within normal range, no treatment is needed for thyroid at present. In auto immune thyroid disease (Hashimoto's), there will be antibodies against thyroid which will try to destroy the thyroid by causing inflammation (swelling) and fibrosis (scarring). This results in decreased hormone production (hypothyroidism).
Initially when the destruction is partial the thyroid will be still producing hormone to have normal T4 and TSH. But the inflammation can symptoms like pain, heaviness, tightness etc in neck due to thyroiditis. Probably you are having all symptoms of thyroiditis now
The treatment of thyroiditis is supportive with analgesics like paracetamol. This will last for few months. In severe cases steroids are indicated.
From the ultrasound findings, thyroid carcinoma is very unlikely. The test we do to find out cancer is needle biopsy (FNAB/FNAC). This test is indicated when the nodule size is more than 1 cm or if there are smaller but suspicious nodules are there - which is not there in your case.
What I do in this situation is follow up thyroid function tests every 3-6 months, do a repeat ultrasound neck after 6-12 months.
2. Hypercalcaemia
High calcium need to evaluated and the tests need to be repeated. The tests that we do are:
1. Fasting calcium, phosphorus, albumin
2. Parathyroid hormone(PTH) - has to be taken in a good lab - collected in ice. If not collected properly, the results can be low.
3. Serum Alkaline phosphatase
4. 24 hour urine for calcium, phosphorus, creatinine
5. Hand X ray - to see any change of hyperparathyroidism
6. 25 hydroxy vitamin D - which is done - low in your case
In a similar situation, with whatever results you have shared with us, my suggestion will be to replace vitamin D and see if calcium is going up above the normal limits.
PTHrp is considered if PTH is low and Calcium is high and phosphorus is low. I think we can consider it as a second line investigations after ruling out hyperparathyroidism.
3. Symptoms
Thyroiditis and vitamin D deficiency may be responsible for some of your symptoms like neck pain and dizziness. I think we will replace vitamin D and wait for the symptoms of thyroiditis to settle by itself.
Wishing you good health.
Hope I have answered your question. If you have any further questions I will be happy to help.
Regards
Dr Ajish TP
Consultant Endocrinologist
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you for your time and your help, doctor. It is very much appreciated. Follow up would be as follows: TSH 1.780 uIU/mL (0.450-4.500 for this labs reference range)
Thyroxine (T4) 7.3 ug/dL (4.5-12.0 for this lab's reference range)
T3 Uptake 24 % units (24-39 for this lab's reference range) I am on the low normal cutoff here it appears.
Free Thyroxine Index 1.8 (1.2-4.9 for this lab's reference range)
This test was done on 12/12/14 whilst I was NOT feeling the tightness and dizziness that I do now. This was also taken earlier than the most recent ones above.
Also, I notice that my calcium level at this point in time was a 10.0 with cutoff being 10.2 for this labs reference range and at that same time my PTH was at 37 (intact) with a 15-65 reference range for the reporting lab)
Question would thyroid cancer cause the fluctuating tightness and swelling in neck as would the Hashimotos dx? As I wake up today, my neck is less full and I can breathe much better but this happens on and off with extreme swallowing and breathing problems every couple days now for weeks. I've been taking Vitamin D supplements for years now. Thank you, Doctor, God bless you! :-)
Thyroxine (T4) 7.3 ug/dL (4.5-12.0 for this lab's reference range)
T3 Uptake 24 % units (24-39 for this lab's reference range) I am on the low normal cutoff here it appears.
Free Thyroxine Index 1.8 (1.2-4.9 for this lab's reference range)
This test was done on 12/12/14 whilst I was NOT feeling the tightness and dizziness that I do now. This was also taken earlier than the most recent ones above.
Also, I notice that my calcium level at this point in time was a 10.0 with cutoff being 10.2 for this labs reference range and at that same time my PTH was at 37 (intact) with a 15-65 reference range for the reporting lab)
Question would thyroid cancer cause the fluctuating tightness and swelling in neck as would the Hashimotos dx? As I wake up today, my neck is less full and I can breathe much better but this happens on and off with extreme swallowing and breathing problems every couple days now for weeks. I've been taking Vitamin D supplements for years now. Thank you, Doctor, God bless you! :-)
Brief Answer:
More likely hashimoto's
Detailed Answer:
Hi XXXX,
Welcome back.
Noted the lab reports. Thyroid function tests are normal. But you are at risk of hypothyroidism as anti thyroid antibodies are high. So periodic follow up of thyroid function function is needed. In my practice I do it at least every 6 months.
Answers to your questions
1. Thyroid cancer can also cause tightness and swelling in neck. But fluctuating symptoms are more seen in thyroiditis. Only by biopsy (FNAC/FNAB) we can make a diagnosis of cancer. I feel you should stop worrying about cancer. If the anxiety of a rare possibility of cancer is troubling you, go ahead with an FNAC which will make things clear.
2. If you are taking vitamin D some times your calcium can go up slightly. Please check your fasting phosphorus and other tests I suggested. If phosphorus is low we need to work up further in line of hyperparathyroidism or PTHrp mediated hypercalcaemia.
Hope this will help you.
Regards
Dr Ajish tp
More likely hashimoto's
Detailed Answer:
Hi XXXX,
Welcome back.
Noted the lab reports. Thyroid function tests are normal. But you are at risk of hypothyroidism as anti thyroid antibodies are high. So periodic follow up of thyroid function function is needed. In my practice I do it at least every 6 months.
Answers to your questions
1. Thyroid cancer can also cause tightness and swelling in neck. But fluctuating symptoms are more seen in thyroiditis. Only by biopsy (FNAC/FNAB) we can make a diagnosis of cancer. I feel you should stop worrying about cancer. If the anxiety of a rare possibility of cancer is troubling you, go ahead with an FNAC which will make things clear.
2. If you are taking vitamin D some times your calcium can go up slightly. Please check your fasting phosphorus and other tests I suggested. If phosphorus is low we need to work up further in line of hyperparathyroidism or PTHrp mediated hypercalcaemia.
Hope this will help you.
Regards
Dr Ajish tp
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Hi Doctor,
A follow up if I may, (thank you for your patience, I apologize), Is there a scan I should get done for my jaw bone with the great and I do mean great and loud cracking going on whenever I talk or eat etc? It's not your everyday run of the mill type tmj thing, wondering if it has something to do with my teeth shifting and neck cracking especially it seems, during these times when my blood calcium is really up there in the 11's.
Thank you again, Doctor. You are a wealth of info and very kind. :-)
God bless you,
Miss XXXX :-)
Immunoglobulin A, Qn, Serum 84 Low mg/dL (91 - 414 reference range for this lab's cutoffs). This was done in November of 2013, 2 months ago. Not sure of the clinical significance of this test is, if this would be helpful in my particular setting. Also, sister has Leukemia, aunt has hx of thyroid cancer.
A follow up if I may, (thank you for your patience, I apologize), Is there a scan I should get done for my jaw bone with the great and I do mean great and loud cracking going on whenever I talk or eat etc? It's not your everyday run of the mill type tmj thing, wondering if it has something to do with my teeth shifting and neck cracking especially it seems, during these times when my blood calcium is really up there in the 11's.
Thank you again, Doctor. You are a wealth of info and very kind. :-)
God bless you,
Miss XXXX :-)
Immunoglobulin A, Qn, Serum 84 Low mg/dL (91 - 414 reference range for this lab's cutoffs). This was done in November of 2013, 2 months ago. Not sure of the clinical significance of this test is, if this would be helpful in my particular setting. Also, sister has Leukemia, aunt has hx of thyroid cancer.
Brief Answer:
ENT evaluation, probable selective Ig A deficiency
Detailed Answer:
Hi XXXX,
Welcome back.
The answers to your questions:
1. I apologise that this time I don't have a confident answer for your first question. Medical condition that explain the cracking sound while eating is only TMJ subluxations and tinnitus in ear. Tinnitus is usually ringing sound in ears. But rarely it can be cracking type and can be really disturbing. The causes of tinnitus is a very long list. I think you should consult a ENT surgeon and have yourselves evaluated. I think scans at this time is not needed.
2. Regarding your second question. I think it is worth repeating the Ig A levels. If it is consistently lower, then it could be a part of immune deficiency called selective IgA deficiency. It makes you at risk of auto immune diseases. No treatment is available.
Regards
Dr Ajish TP
ENT evaluation, probable selective Ig A deficiency
Detailed Answer:
Hi XXXX,
Welcome back.
The answers to your questions:
1. I apologise that this time I don't have a confident answer for your first question. Medical condition that explain the cracking sound while eating is only TMJ subluxations and tinnitus in ear. Tinnitus is usually ringing sound in ears. But rarely it can be cracking type and can be really disturbing. The causes of tinnitus is a very long list. I think you should consult a ENT surgeon and have yourselves evaluated. I think scans at this time is not needed.
2. Regarding your second question. I think it is worth repeating the Ig A levels. If it is consistently lower, then it could be a part of immune deficiency called selective IgA deficiency. It makes you at risk of auto immune diseases. No treatment is available.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hello Dr,
I have noticed something very interesting tonight. I notice that EVERY SINGLE TIME
I eat XXXXXXX stuffed clam on the half shell, my ax's automatically get worse! So, what happens is this: As soon as I eat clam on the half shell, I wait maybe 20 mins approximated time, and my throat gets so tight and I start having problems breathing. The lump in my throat keeps getting bigger. I become out of breath big time. This is new to me. I've always enjoyed eating these, but I swear as soon as all of this started it started with me eating these. Could it be the iodine/Hashimotos correlation? Thank you for your time and help. Miss XXXX :-)
sorry, that typo should have read sx's (Symptoms). :-)
I have noticed something very interesting tonight. I notice that EVERY SINGLE TIME
I eat XXXXXXX stuffed clam on the half shell, my ax's automatically get worse! So, what happens is this: As soon as I eat clam on the half shell, I wait maybe 20 mins approximated time, and my throat gets so tight and I start having problems breathing. The lump in my throat keeps getting bigger. I become out of breath big time. This is new to me. I've always enjoyed eating these, but I swear as soon as all of this started it started with me eating these. Could it be the iodine/Hashimotos correlation? Thank you for your time and help. Miss XXXX :-)
sorry, that typo should have read sx's (Symptoms). :-)
Brief Answer:
It could be due to high iodine
Detailed Answer:
Hi Ms XXXX,
Welcome back.
Nice observation. High iodine diet can sometime worsen the symptoms in early thyroiditis. This is due to iodine getting concentrated in thyroid and thyroid swell up in response to that.
Don't worry. These symptoms decrease with time and you can enjoy clam again.
Regards
Dr Ajish TP
It could be due to high iodine
Detailed Answer:
Hi Ms XXXX,
Welcome back.
Nice observation. High iodine diet can sometime worsen the symptoms in early thyroiditis. This is due to iodine getting concentrated in thyroid and thyroid swell up in response to that.
Don't worry. These symptoms decrease with time and you can enjoy clam again.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Excellent news about the clams. :-D
I notice on one of my old sestamibi ct/spect scans that physiological activity was seen in salivary glands, heart, kidneys, etc, (off the top of my head I do not have the report in front of me), and while I do not believe that that is anything to worry about at all, I do not know what the normal patterns of physiologic uptake of the sestamibi radioactive tracer would be in that situation. Any info you could give me there on this would be greatly appreciated.
Also, I notice that around what I believe to be my hyoid bone, a large mass seems to go in and out or inside or and back out again, to the point I have to tilt my head back and try to forcefully cough to try to get the mass out again, (if this makes any sense at all), Very uncomfortable, ever run into that in your practice?
Interesting to note as an aside to the above, when this mass pops in and out, I, and those around me can hear an audible clicking corresponding to what is going on.
Forgot to mention, this also prompts coughing as if someone were forcefully putting their hands around my neck choking me until I can "Cough" it out into place again. I know this sounds weird but it's what happens.
I notice on one of my old sestamibi ct/spect scans that physiological activity was seen in salivary glands, heart, kidneys, etc, (off the top of my head I do not have the report in front of me), and while I do not believe that that is anything to worry about at all, I do not know what the normal patterns of physiologic uptake of the sestamibi radioactive tracer would be in that situation. Any info you could give me there on this would be greatly appreciated.
Also, I notice that around what I believe to be my hyoid bone, a large mass seems to go in and out or inside or and back out again, to the point I have to tilt my head back and try to forcefully cough to try to get the mass out again, (if this makes any sense at all), Very uncomfortable, ever run into that in your practice?
Interesting to note as an aside to the above, when this mass pops in and out, I, and those around me can hear an audible clicking corresponding to what is going on.
Forgot to mention, this also prompts coughing as if someone were forcefully putting their hands around my neck choking me until I can "Cough" it out into place again. I know this sounds weird but it's what happens.
Brief Answer:
See detailed answers
Detailed Answer:
Hi XXXX,
Welcome back.
The answers to your questions.
1. Sesta mibi scan
Sesta mibi scan is used to detect any adenoma (benign tumour ) in parathyroid. It measures the cellular activity. If a single adenoma is responsible for hypercalcaemia it will show as a bright spot. The normal activity of salivary glands, heart, kidney etc will be seen in this scan. Parathyroids are usually not visible in this scan and if visible it is due to increased activity in a parathyroid tumour.
2. Swelling in neck
It is interesting to note that this swelling was not detected in your Ultrasound scan. The only explanation I can give is by a condition called Zenker's diverticulum. Here the lower pharynx will swell out intermittently and may lead to cough and swallowing difficulty. I think meeting an ENT surgeon will help you.
Hope this will clear your concerns
Regards
Dr Ajish TP
See detailed answers
Detailed Answer:
Hi XXXX,
Welcome back.
The answers to your questions.
1. Sesta mibi scan
Sesta mibi scan is used to detect any adenoma (benign tumour ) in parathyroid. It measures the cellular activity. If a single adenoma is responsible for hypercalcaemia it will show as a bright spot. The normal activity of salivary glands, heart, kidney etc will be seen in this scan. Parathyroids are usually not visible in this scan and if visible it is due to increased activity in a parathyroid tumour.
2. Swelling in neck
It is interesting to note that this swelling was not detected in your Ultrasound scan. The only explanation I can give is by a condition called Zenker's diverticulum. Here the lower pharynx will swell out intermittently and may lead to cough and swallowing difficulty. I think meeting an ENT surgeon will help you.
Hope this will clear your concerns
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Raju A.T
Hello doctor and thank you for your patience and wealth of information. It is very much appreciated.
I would like to know if in light of my increase in A/G ratio along with long HX of hypercalcemia and low iga level, you could recommend to me any other testing I could add to my tests I will get tomorrow. I would like to go ahead and get everything out of the way and get those results and post them to you and get any feedback you might have about them. Thanks again. Miss XXXX :-D
I would like to know if in light of my increase in A/G ratio along with long HX of hypercalcemia and low iga level, you could recommend to me any other testing I could add to my tests I will get tomorrow. I would like to go ahead and get everything out of the way and get those results and post them to you and get any feedback you might have about them. Thanks again. Miss XXXX :-D
Brief Answer:
Get the investigations, accordingly can plan second line of investigations.
Detailed Answer:
Hi XXXX,
Good day.
The high A/G ratio is due to low immunoglobulin. The investigations I would suggest you are:
Thyroid function tests
Fasting calcium, phosphorus, albumin
Urine calcium creatinine ratio
Serum alkaline phosphatase
Based on these results , we can plan the second line investigations. (25 hydroxy vitamin D, serum PTH (properly collected in ice), Ultrasound kidneys, x ray hand )
Wishing you good health
Regards
Dr Ajish TP
Get the investigations, accordingly can plan second line of investigations.
Detailed Answer:
Hi XXXX,
Good day.
The high A/G ratio is due to low immunoglobulin. The investigations I would suggest you are:
Thyroid function tests
Fasting calcium, phosphorus, albumin
Urine calcium creatinine ratio
Serum alkaline phosphatase
Based on these results , we can plan the second line investigations. (25 hydroxy vitamin D, serum PTH (properly collected in ice), Ultrasound kidneys, x ray hand )
Wishing you good health
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Hello doctor,
Have you had any women try minoxidil for the severe hair loss due to these thyroid issues? It's getting pretty bad for me. Have you seen it work or maybe even prescribed it for your female patients? If you have, were the results even 10 percent better? Thank you for your insight. It is so very much appreciated and valued. :-)
Have you had any women try minoxidil for the severe hair loss due to these thyroid issues? It's getting pretty bad for me. Have you seen it work or maybe even prescribed it for your female patients? If you have, were the results even 10 percent better? Thank you for your insight. It is so very much appreciated and valued. :-)
Brief Answer:
The results are good if used for prolonged period
Detailed Answer:
Hi Ms XXXX,
Welcome back.
We use Minoxidil in women with hair loss after ruling out hypothyroidism, iron, calcium and vitamin deficiency. In my practice I use 2% solution in women with female pattern hair loss. Higher concentration leads to facial hair growth in women.
The results will be seen only after twice daily use of 4-6 months. It has to be used continuously for preventing hair loss.
Regards
Dr Ajish TP
The results are good if used for prolonged period
Detailed Answer:
Hi Ms XXXX,
Welcome back.
We use Minoxidil in women with hair loss after ruling out hypothyroidism, iron, calcium and vitamin deficiency. In my practice I use 2% solution in women with female pattern hair loss. Higher concentration leads to facial hair growth in women.
The results will be seen only after twice daily use of 4-6 months. It has to be used continuously for preventing hair loss.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Ashwin Bhandari
Hello Doctor,
Thank you so much for the information.
Can you tell me anything about the current set of sx's I am experiencing today which is the following: My left hand bone right under my pinky finger, is severely swollen and has the most incredible bone pain. It is nearly impossible to even consider touching. It is that painful.
A week before this, it was the same way with my left foot on the underside of my little toe. (same thing, like the bone part right under and alongside my little toe side was swollen and incredibly tender and swollen which made it hard to walk on).
Thank you for any information and suggestions you have for me as always. :-D
Thank you so much for the information.
Can you tell me anything about the current set of sx's I am experiencing today which is the following: My left hand bone right under my pinky finger, is severely swollen and has the most incredible bone pain. It is nearly impossible to even consider touching. It is that painful.
A week before this, it was the same way with my left foot on the underside of my little toe. (same thing, like the bone part right under and alongside my little toe side was swollen and incredibly tender and swollen which made it hard to walk on).
Thank you for any information and suggestions you have for me as always. :-D
Brief Answer:
Check your uric acid, blood routine, alkaline phos
Detailed Answer:
Hi Ms XXXX,
Noted your concerns.
Pain and swelling in the background of your health issues due to
1. Hyperparathyroidism - bone resorption resulting in hypercalcaemia will decrease the bone strength and cause small micro fractures
2. High uric acid can lead to gout
3. Unrelated situations- like small joint arthritis
So kindly do a serum uric acid, alkaline phosphatase, blood routine, ESR and X-ray hand.
Regards
Dr Ajish TP
Check your uric acid, blood routine, alkaline phos
Detailed Answer:
Hi Ms XXXX,
Noted your concerns.
Pain and swelling in the background of your health issues due to
1. Hyperparathyroidism - bone resorption resulting in hypercalcaemia will decrease the bone strength and cause small micro fractures
2. High uric acid can lead to gout
3. Unrelated situations- like small joint arthritis
So kindly do a serum uric acid, alkaline phosphatase, blood routine, ESR and X-ray hand.
Regards
Dr Ajish TP
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Hello Doctor,
I am awaiting those requested blood tests and should have them back tomorrow.
I am on a reverse sleeping schedule. In other words, when most people go to sleep, I wake up, and vice versa. I've done research and realized that Calcium and PTH levels fall into some kind of circadian or nocturnal/diurnal rhythm (for lack of a better way of my describing). It seems that when I go for these tests, I have been doing so at around 1650 hours to 1800 hours, around 4pm to 6pm in the late afternoon.
Typically, and for the last several years, my work/school schedule has been this way for the last 5 years or so. I go to sleep at around 0700 in the morning to around 1000 hours. (7am-10am). I see the fluctuations in normal healthy volunteers during many phases of their normal sleep/wake cycle.
Following this logic, can you please tell me, because I have no idea, when the best time for someone like me to test both Calcium/PTH levels. As I notice that the lab tests I am getting my workups done say with a clear warning at the top of my paper results "Calcium and PTH levels should be done BEFORE 0900 (9am) although we will accept any hour after this."
Sir, could you please offer any help as to when would be the very best optimal time for someone with my reversed schedule to test these blood parameters? I've read that it is not as simple as just reversing one's altered sleep cycle. But I trust your experience completely.
Thank you so very much for your knowledge and perspective. It really means so much to me. Miss XXXX :-)
I am awaiting those requested blood tests and should have them back tomorrow.
I am on a reverse sleeping schedule. In other words, when most people go to sleep, I wake up, and vice versa. I've done research and realized that Calcium and PTH levels fall into some kind of circadian or nocturnal/diurnal rhythm (for lack of a better way of my describing). It seems that when I go for these tests, I have been doing so at around 1650 hours to 1800 hours, around 4pm to 6pm in the late afternoon.
Typically, and for the last several years, my work/school schedule has been this way for the last 5 years or so. I go to sleep at around 0700 in the morning to around 1000 hours. (7am-10am). I see the fluctuations in normal healthy volunteers during many phases of their normal sleep/wake cycle.
Following this logic, can you please tell me, because I have no idea, when the best time for someone like me to test both Calcium/PTH levels. As I notice that the lab tests I am getting my workups done say with a clear warning at the top of my paper results "Calcium and PTH levels should be done BEFORE 0900 (9am) although we will accept any hour after this."
Sir, could you please offer any help as to when would be the very best optimal time for someone with my reversed schedule to test these blood parameters? I've read that it is not as simple as just reversing one's altered sleep cycle. But I trust your experience completely.
Thank you so very much for your knowledge and perspective. It really means so much to me. Miss XXXX :-)
Brief Answer:
Fasting for 6 hours, preferably morning samples
Detailed Answer:
Hi XXXX,
Welcome back. Good day
Noted your concerns.
The circadian rhythm of calcium and PTH is not consistently established. Highest values are seen in evening after 8 pm. But the difference between highest and lowest values are not marked to affect your diagnosis. So we won't insist on timing of serum PTH. For calcium we recommend fasting for 6 hours.
So even if your sleep rhythm is altered it won't affect your PTH and calcium tests.
If you have any further queries I will be happy to help you.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Fasting for 6 hours, preferably morning samples
Detailed Answer:
Hi XXXX,
Welcome back. Good day
Noted your concerns.
The circadian rhythm of calcium and PTH is not consistently established. Highest values are seen in evening after 8 pm. But the difference between highest and lowest values are not marked to affect your diagnosis. So we won't insist on timing of serum PTH. For calcium we recommend fasting for 6 hours.
So even if your sleep rhythm is altered it won't affect your PTH and calcium tests.
If you have any further queries I will be happy to help you.
Regards,
Dr Ajish TP [MD,DM]
Consultant Endocrinologist
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Yogesh D
Answered by
Get personalised answers from verified doctor in minutes across 80+ specialties
