Our Summary
This research paper looked at how effective surgery is for treating a condition called tertiary hyperparathyroidism. This is a condition where the parathyroid glands in the neck produce too much parathyroid hormone, leading to high levels of calcium in the blood. The researchers looked at lots of different studies and found that surgery, specifically parathyroidectomy, is a good treatment option for this condition.
They found that the main reason for having surgery was if the patient had symptoms caused by having too much calcium in their blood, despite being on medication. It’s not recommended to do surgery just because they have hyperparathyroidism.
The studies suggest that it’s better to remove only part of the parathyroid glands, rather than all of them, when possible. The aim of the surgery isn’t necessarily to get the parathyroid hormone levels back to normal, but to reduce them by at least half. The most important thing is to get the patient’s calcium levels back to normal, even if their parathyroid hormone levels are still a bit high.
This means that a successful operation is one that results in normal calcium levels six months after the surgery, regardless of whether the parathyroid hormone levels are still above normal.
FAQs
- What is tertiary hyperparathyroidism and how can it be treated?
- Is parathyroidectomy recommended for all patients with hyperparathyroidism?
- What is considered a successful outcome of a parathyroidectomy?
Doctor’s Tip
One helpful tip a doctor might tell a patient about parathyroidectomy is to follow up regularly with their healthcare provider to monitor their calcium levels and overall health after surgery. It’s important to continue taking any prescribed medications and to report any new or worsening symptoms to their doctor. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help support recovery and overall well-being.
Suitable For
Patients who are typically recommended for parathyroidectomy are those with severe symptoms of hyperparathyroidism, such as kidney stones, bone pain, fatigue, and high calcium levels in the blood. These symptoms can significantly impact a patient’s quality of life and may not be adequately controlled with medication alone.
Additionally, patients who have failed medical management of their hyperparathyroidism, such as not responding well to medication or experiencing side effects, may also be recommended for surgery. This is especially true for patients with tertiary hyperparathyroidism, where the parathyroid glands have become autonomous and are no longer responsive to medication.
Patients with complications of hyperparathyroidism, such as osteoporosis, kidney disease, or cardiovascular issues, may also be candidates for parathyroidectomy to help improve their overall health and reduce the risk of further complications.
Overall, the decision to recommend parathyroidectomy is based on the severity of symptoms, the effectiveness of medical management, and the potential benefits of surgery in improving the patient’s health and quality of life.
Timeline
Before the parathyroidectomy, the patient will typically undergo a series of tests to confirm the diagnosis of hyperparathyroidism and determine the best course of treatment. This may include blood tests, imaging studies such as ultrasound or sestamibi scans, and possibly a biopsy.
After the surgery, the patient may experience some pain and discomfort at the incision site, which can usually be managed with pain medication. They may also need to stay in the hospital for a day or two for monitoring.
In the weeks and months following the surgery, the patient will have follow-up appointments with their healthcare provider to monitor their calcium and parathyroid hormone levels. It may take some time for these levels to normalize, but the goal is for the patient to eventually have normal calcium levels and improved symptoms.
Overall, the timeline for a patient before and after parathyroidectomy involves preoperative testing, surgery, postoperative recovery, and ongoing monitoring to ensure that the surgery was successful in treating their hyperparathyroidism.
What to Ask Your Doctor
Some questions a patient should ask their doctor about parathyroidectomy include:
- What are the potential risks and complications of parathyroidectomy?
- How experienced are you in performing parathyroidectomy procedures?
- Will I need to take any medications or supplements after the surgery?
- How long is the recovery period after parathyroidectomy?
- What will my follow-up care look like after the surgery?
- Will I need any additional tests or imaging before the surgery?
- How likely is it that my symptoms will improve after the surgery?
- What is the success rate of parathyroidectomy for treating tertiary hyperparathyroidism?
- Are there any lifestyle changes I should make before or after the surgery?
- Are there any alternative treatment options for my condition?
Reference
Authors: Tang JA, Friedman J, Hwang MS, Salapatas AM, Bonzelaar LB, Friedman M. Journal: Am J Otolaryngol. 2017 Sep-Oct;38(5):630-635. doi: 10.1016/j.amjoto.2017.06.009. Epub 2017 Jun 21. PMID: 28735762