congestive heart failure and hyperparathyroidism

[fayme]

hI there

My mother (73) in the last 4 months has had a cough, nausea, loss of appetite, weight loss, fatigue adn some loss of interest and unreliable memory. About 4 months ago a very minor exertion resulted in a broken bone and in the last month also a further break for a minor incident. In october she was diagnosed to have osteoporosis and given calcium that she couldn't take as it made her sick so she now stopped.
The cough, weight loss, nausea etc has continued and worsened. About november blood tests came back broadly normal but with signs of start of stones in kidney. Symptoms continued and she ended up in hospital on boxing day for a week almost comatose at first and with this nasty fluidy cough.
They now say she has congestive heart failure (CHF) and have her on furosemide and bisoprolol to which she is responding but I think the congestive heart failure is a symptom or result of a long term untreated hyperparathyroidism (HPT).
However neither she nor her doctors will look into HPT but only are treating the CHF. I understand that in 7-12 % of cases of HPT disease the patients' blood tests never show significantly elevated HPT or calcium but they are hard to diagnose. Am I right to suspect HPT? How do we get people to look into HPT as well as only looking at CHF.

[John Kenyon, CNA]

Hello -

Your mother certainly does fit the profile for HPT, and has many of the collective signs and symptoms. As to why this hasn't been explored, it's difficult to know, but it is often overlooked, especially in patients who are seen as "older", even though your mother isn't especially old by today's standards. Unfortunately, physical condition is often used as the measure of "age." Since your mother came in already in rough condition, she may be seen as older than she actually is, and HPT may not be considered worth the effort, since the only thing that isn't being done for her now that would be done otherwise would be surgery on the hyperthyroid, which in the past was generally neglected as a therapy. It's done more often now, and though it is difficult to guess how this might affect the course of her illness, it seems not unreasonable, and since everything else being done would be done for someone with HPT, it should be almost the default diagnosis.

All that considered, I would think the best way to get someone to consider HPT would be to be a pest and advocate for your mother and aggressively insist on a PTH immunoessay being done to find out if she has it or not. Then, if positive, the potential for surgery would have to at least be discussed.

I hope this is helpful to you. Please follow up with us as needed, and update us if anything changes. Good luck to you and to your mother.