Our Summary

This research paper is about a study carried out in Brazil to determine whether it is effective to perform surgery for a condition called hyperparathyroidism related to chronic kidney disease, without a preoperative exam called MIBI. Hyperparathyroidism is a condition where the parathyroid glands produce too much hormone, which can lead to high calcium levels in the blood. MIBI is a type of scan that is often used to find the overactive parathyroid gland before surgery, but it is expensive and can be hard to access in Brazil.

The researchers performed surgery on 114 patients without doing the MIBI scan first. They found that the surgery was successful in 93.8% of cases, with only 7 failures. In these unsuccessful cases, the surgeons were not able to find all the parathyroid glands. One patient remained with high calcium levels after the surgery and was diagnosed with a supernumerary parathyroid gland (an extra one).

The study concluded that the surgery is an effective and repeatable treatment for hyperparathyroidism related to chronic kidney disease, even without the MIBI scan. This could be good news for patients in Brazil and other countries where access to the scan is limited.

FAQs

  1. What is the purpose of the MIBI scan in treating hyperparathyroidism?
  2. According to the study, what was the success rate of the surgery without the MIBI scan?
  3. What were the issues in the unsuccessful cases of the surgery performed without the MIBI scan?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to follow all pre-operative instructions provided by the medical team. This may include fasting before the surgery, stopping certain medications, and avoiding smoking or alcohol. Following these instructions can help ensure a successful surgery and smooth recovery.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with:

  1. Primary hyperparathyroidism: This is the most common reason for parathyroidectomy. It occurs when one or more of the parathyroid glands become overactive and produce too much parathyroid hormone, leading to high levels of calcium in the blood.

  2. Secondary hyperparathyroidism: This condition often occurs in patients with chronic kidney disease, as the kidneys are unable to properly regulate calcium and phosphorus levels in the blood. Parathyroidectomy may be recommended if medical management is not effective in controlling the overproduction of parathyroid hormone.

  3. Tertiary hyperparathyroidism: This is a rare condition that can develop in patients with long-standing secondary hyperparathyroidism. It occurs when the parathyroid glands become autonomous and continue to produce excess hormone even after the underlying cause (such as chronic kidney disease) has been treated. Parathyroidectomy may be recommended in these cases to control high calcium levels.

  4. Severe symptoms: Patients with symptoms such as bone pain, kidney stones, fatigue, and muscle weakness may be recommended for parathyroidectomy to alleviate their symptoms and improve their quality of life.

Overall, the decision to recommend parathyroidectomy will depend on the specific circumstances of each patient, including their symptoms, calcium levels, kidney function, and response to medical management. It is important for patients to discuss their treatment options with their healthcare provider to determine the most appropriate course of action.

Timeline

Before parathyroidectomy:

  1. Patient is diagnosed with hyperparathyroidism related to chronic kidney disease.
  2. Patient may undergo various blood tests and imaging studies to confirm the diagnosis.
  3. Patient may be recommended to undergo a preoperative exam called MIBI to locate the overactive parathyroid gland.
  4. Surgery is scheduled once the overactive gland is located.

After parathyroidectomy:

  1. Surgery is performed to remove the overactive parathyroid gland.
  2. Patient is monitored closely postoperatively for any complications.
  3. Patient may experience a decrease in symptoms related to high calcium levels such as fatigue, bone pain, and kidney stones.
  4. Patient undergoes follow-up blood tests to monitor calcium levels and ensure the surgery was successful.
  5. Patient may require calcium and vitamin D supplements postoperatively to maintain normal calcium levels.
  6. Patient may experience improved quality of life and overall health following successful surgery.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a parathyroidectomy surgery?
  2. How long is the recovery period after the surgery, and what can I expect during that time?
  3. Will I need to take any medications or follow a special diet after the surgery?
  4. Are there any long-term effects of having a parathyroidectomy?
  5. How will the surgery affect my calcium levels and overall health?
  6. Are there any alternative treatments or options for managing hyperparathyroidism?
  7. Will I need to have regular follow-up appointments or tests after the surgery?
  8. What experience do you have with performing parathyroidectomy surgeries, and what is your success rate?
  9. How will I know if the surgery was successful, and what are the signs of potential complications that I should watch out for?
  10. Are there any specific instructions or guidelines I should follow before and after the surgery to ensure the best possible outcome?

Reference

Authors: Neves MCD, Abrahão AR, Abrahão M, Rosano M, Rocha LAD, Machado HKAG, Santos RO. Journal: Braz J Otorhinolaryngol. 2022 Sep-Oct;88(5):740-744. doi: 10.1016/j.bjorl.2020.10.009. Epub 2020 Nov 16. PMID: 33303418