Pathology and endocrine testing
Prior to assessment at Melbourne Parathyroid Centre, it is recommended to have had, at minimum, 2 recent but separate sets of blood tests for serum Calcium, Corrected Calcium, PTH (parathyroid Hormone) and Vitamin D.
If there is any uncertainty about the diagnosis, It is also advised to have a 24 hour urine collection for Calcium excretion and creatinine excretion allowing us to calculate the urine Calcium/Creatinine ratio, which helps us to confirm the diagnosis.
A bone density test-DEXA scan is frequently a good idea. People with hyperparathyroidism are at extra risk of osteoporosis and it is useful to identify and to treat it. In some cases where the hyperparathyroidism is very mild and you may be considering waiting, the presence of osteoporosis may be an indication to undergo parathyroid surgery earlier.
Your General Practitioner or Endocrinologist can order these tests.
Imaging or scans
In general, we prefer to arrange Imaging tests with a select team of experts here at St Vincent’s campus. This allows us to utilise state of the art technology and methodology, review the images as a team, and constantly review the service and provide the best possible results. We can arrange this after referral and prior to your consultation.
( Melbourne Parathyroid Centre does not request or receive any financial or other reward or “kickback” from radiology or pathology services)
Parathyroid adenomas are often quite small, less than one centimetre in size. They can have variable characteristics on imaging. The neck and chest are full of other small lumps such as lymph nodes (glands), thyroid nodules, thymus and blood vessels and it can be difficult to distinguish between them. You need expert radiologists who specialise in these studies.
Ultrasound
Ultrasound scanning is a key part of the assessment and may be performed more than once in the course of investigation and treatment.
Nuclear Medicine Sestamibi scan and or “4D” CT
Both of these tests have their place and may be ordered alone or at times sequentially.
Note: The success and accuracy of imaging tests for parathyroid localisation is highly variable between different imaging services. Results are very much dependent on the level of experience of those performing the tests, the number of patients scanned per year and the level of interest, passion and time invested in performing the tests. Best results are also achieved with up to date equipment and protocols and in a service which reviews the results against the findings at surgery.
There are of course a number of alternate centres in Australia with expertise in imaging, but please avoid choosing simply the most convenient site, particularly in country towns, and private, suburban radiology clinics. Often it will be a waste of your money and government money. Do your research first before booking.
