Nešto u ovom vasem izlaganju ne stima. Idemo redom:

Potrebna mi je pomoć u razumevanju rezultata scintigrafije parastitne zlezde.
KOMENTAR
Vi vjerovatno znate da u neposrednoj blizini stitne ljezde Thyroidea ima i 4 male zljezde velicine zrna rize koje cine Parathyroidnu zljezdu.

Dalje vas navod:
Prilozicu nalaz scintigrafije, osoba je zenskog pola 67 godina stara sa 10-tak godina prisutnom hipofunkcijom stitne zlezde.ultrazvuci su radjeni pre 5 godina i pokazivali na prisustvo tzv.cvorova.Tada nije radjena scintigrafija niti bilo koje drugo snimanje.Terapija je bila hormonalna.
KOMENTAR:
Ovdje se radio UZ stitne zljezde a trebalo je uraditi i TSH, T3, T4, MRI, Biopsija, pregled krvi na Ca, P, Mg i nivo Parathyroidnog hormona.

Sledeći navod:
Pri zadnjem laboratorijskom nalazu,usled povecanog kalcijuma a smanjenog fosfora,predlaze se scintigrafija paratireoidne zlezde.Hormoni stitne su u granicama normale.
KOMENTAR:
Ne razumem zašto nije radjen nivo Parathyroidnog hormona u krvi.

VAS LEDECI NAVOD;
Scintigrafija paratireoidnih zlezda uradjena je 15 ( rana faza ) i 120 minuta (kasna faza ) nakon aplikacije 370 MBq radiofarmaka.
Stitasta zlazda je odgovarajuceg polozaja i velicine,lako nepravilno ocrtanih kontura.Distribucija radiofarmaka je nehomogena i lako pojacana u sredisnjim partijama i u nivou gornjeg pola desnog reznja u ranoj fazi snimanja.U kasnoj fazi snimanja dolazi do iscezavanja radioaktivnosti iz regije gornjeg pola,a zaostaje kruzno polje pojacane akumulacije radiofarmaka u sredisnjim partijama desnog reznja.
Zakljucak:
Nalaz visokom verovatnocom ukazuje na prisustvo hiperfunkcijskog paratireoidnog adenoma.
KOMENTAR:
Nalaz je zaista neobično napisan. Opisuje se stitna zljezda a govori se o adenomu Parathyroidne zljezde desno. Ako je mogao iskljuciti stitnjacu, nejasno je zašto nije napisao da je desno povecan jedan ili dva cvora jer ih imaju dva desno i dva lijevo. Ako je desno uvecan jedan tada je trebao opisati koji je od desnih cvorova uvecan i tacnu lokaciju istog.
KOMENTAR:
Na oosnovu povecanog nivoa Ca i niskog nivoa P (Fosfora) te na osnovu normalnih nalaza hormona stitnjace TSH, T3 i T4, može se pretpostaviti da je u pitanju parathyroidna zljezda, čija je funkcija pojacana. Najcesci uzrok povecane funkcije je Adenom.
Dijagnoza se treba dopuniti sa MRI i krvnim pregledom nivoa Parathyroidnog hormona.
Sam adenom nije opasan i nije cancer. Lijecenje je jednostavno kirusko da se odstrani navedeni uvecani cvor. Ako nalazi Ca i Parathormona nisu jako povecani može se i pratiti. Ovdje se prate i nivo Mg (Magnezija), te denzitet kostiju
Savjet: Trebate traziti dopunu pretraga a ako treba i biosija i to naciniti. Na osnovu dobijenih nalaza se pristupa terapiji. U svako slučaju nije zabrinjavajuce stanje

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Prvo u vezi dijagnostike obolele Parathyroidne zljezde (PTZ).
- Pregled krvi na Ca, P, Mg i Parathirodni hormon (PTH)
- Kompletni denzitet kostiju (Radi se DXA scen)
- Pregled urina (nokrace) da se proceni stanje bubrega radi Ca koji se izlucuje i kolicina Ca koja se islucuje preko mokkrace)
- Slikanje bubrega radi mogućih kamenaca
- UZ PTZ da se prikaze PTZ i okolno tkivo.
- Sestamib scen . Skeniranje PHZ sa davanjem u venu Sestamiba. To je posebna radioaktivna komponenta koja se absorbuje u PTZ koja ima pojacanu funkciju. Ovo sluzi i za lokalizaciju cvora koji ima pojacanu funkciju.

LIJECENJE:
Kako se to radi i koju varijantu izabrati, treba dosta pisati a ja ću vam dati link kako se to radi u Mayo Clinici. Ukoliko neznate engleski navedite pa ću to u skracenoj verziji nappisati. A tekst kako se to lijeci:

Treatments and drugs
By Mayo Clinic staff

Watchful waiting
Your doctor may recommend no treatment and regular monitoring if:

* Your calcium levels are only slightly elevated
* Your kidneys are functioning normally
* Your bone density is normal or only slightly below normal
* You have no other symptoms that may improve with treatment

If you choose this watch-and-wait approach, you'll likely need a test to check your blood-calcium levels at least twice a year and have other monitoring tests done at least once a year.

Surgery
Surgery is the most common treatment for primary hyperparathyroidism and provides a cure in at least 90 percent of all cases. A surgeon will remove only those glands that are enlarged or have a tumor (adenoma). If all four glands are affected, a surgeon will likely remove only three glands and perhaps a portion of the fourth — leaving some functioning parathyroid tissue.

Surgery may be done as an outpatient procedure, allowing you to go home the same day. In such cases, the surgery is done through very small incisions in the neck, and you receive only local anesthetics.

Complications from surgery aren't common. Risks include:

* Damage to nerves controlling the vocal cords
* Long-term low calcium levels requiring the use of calcium and vitamin D supplements

Drugs
Medications to treat hyperparathyroidism include the following:

* Calcimimetics. A calcimimetic is a drug that mimics calcium circulating in the blood. Therefore, the drug may trick the parathyroid glands into releasing less parathyroid hormone. This drug is sold as cinacalcet (Sensipar). The Food and Drug Administration approved cinacalcet to treat hyperparathyroidism caused by chronic kidney disease or parathyroid cancer. Some doctors may prescribe it to treat primary hyperparathyroidism, particularly if surgery hasn't successfully cured the disorder or a person isn't a good candidate for surgery.
* Hormone replacement therapy. For women who have gone through menopause and have signs of osteoporosis, hormone replacement therapy may help bones retain calcium. This treatment, usually a combination estrogen and progestin, doesn't address the underlying problems with the parathyroid glands. Prolonged use of hormone replacement therapy can increase the risk of cardiovascular disease and some cancers. Work with your doctor to evaluate the risks and benefits to help you decide what's best for you.
* Bisphosphonates. Bisphosphonates also prevent the loss of calcium from bones and may lessen osteoporosis caused by hyperparathyroidism.

Lifestyle and home remedies

AKO ZELITE LIJECITI RADIJE NEGO OPERATIVNI ZAHVAT EVO O TOMT OD IST KLINIKE

If you and your doctor have chosen to monitor, rather than treat, your hyperparathyroidism, the following suggestions can help prevent complications:

* Monitor how much calcium and vitamin D you get in your diet. Limit your intake of calcium to about 1,000 to 1,200 milligrams a day and your intake of vitamin D to about 400 to 600 international units a day. Talk to your doctor about dietary guidelines that are appropriate for you.
* Drink plenty of water. Drink six to eight glasses of water daily to lessen the risk of kidney stones.
* Exercise regularly. Regular exercise, including strength training, helps maintain strong bones. Talk to your doctor about what type of exercise program is best for you.
* Don't smoke. Smoking may increase bone loss as well as increase your risk of a number of serious health problems. Talk to your doctor about the best ways to quit.
* Avoid calcium-raising drugs. Certain medications, including some diuretics and lithium, can raise calcium levels. If you take such drugs, ask your doctor whether another medication may be appropriate for you.

Ja mislim da u ovim tekstovima imate odgovor na sva vasa pitanja.
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