Our Summary

Secondary hyperparathyroidism is a condition that often develops in chronic kidney disease (CKD) patients due to a combination of vitamin D deficiency, low calcium levels, and high phosphate levels. This condition is present in almost all patients when they start dialysis.

The paper discusses the use of vitamin D analogs and calcimimetics (drugs that mimic the action of calcium on tissues) in treating this condition. However, their use is limited due to problems with calcium levels, patient compliance, side effects, and cost.

If a patient’s parathyroid hormone level remains over 800 pg/ml for more than six months despite medical treatment, it is likely that the patient has a monoclonal proliferation with nodular hyperplasia, a type of abnormal tissue growth. In such cases, surgical removal of the parathyroid glands, known as parathyroidectomy, should be considered.

Parathyroidectomy has been found to offer significant benefits. It is associated with 15%-57% greater survival in patients on dialysis and improves calcium and phosphate levels, bone mineral density, and quality of life. However, the rate of parathyroidectomy in the US declined between 2002 and 2011, despite an increase in average parathyroid hormone levels.

The surgery does carry risks, including a 39% higher hospitalization rate in the first year after surgery and a condition called “hungry bone syndrome” in about 25% of patients on dialysis. This syndrome, characterized by a sudden decrease in calcium levels, requires high doses of calcium and calcitriol supplementation.

In conclusion, despite the surgical risks and postoperative challenges, the paper suggests that parathyroidectomy could be a viable treatment option for more patients with secondary hyperparathyroidism that doesn’t respond to medication.

FAQs

  1. What is secondary hyperparathyroidism and who is most likely to develop this condition?
  2. What are the benefits and risks associated with parathyroidectomy and when should it be considered as a treatment option?
  3. What is “hungry bone syndrome” and how is it managed after parathyroidectomy?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to closely monitor their calcium levels after surgery and follow their healthcare provider’s recommendations for calcium and vitamin D supplementation. It’s important to communicate any symptoms of low calcium levels, such as muscle cramps, tingling in the fingers and toes, or changes in heart rate, to their healthcare team promptly. Regular follow-up appointments and blood tests will help ensure the patient’s calcium levels are well-managed post-surgery.

Suitable For

Typically, patients who are recommended for parathyroidectomy are those with chronic kidney disease and secondary hyperparathyroidism who have not responded to medical treatment and have persistently high parathyroid hormone levels. These patients may have complications such as abnormal tissue growth in the parathyroid glands, leading to nodular hyperplasia. Parathyroidectomy may also be considered for patients who experience severe symptoms and complications related to their secondary hyperparathyroidism, such as bone mineral density loss and poor quality of life. It is important for patients to discuss the potential risks and benefits of parathyroidectomy with their healthcare providers to determine if it is the right treatment option for them.

Timeline

Before parathyroidectomy, a patient with secondary hyperparathyroidism due to chronic kidney disease will likely have been on medical treatment such as vitamin D analogs and calcimimetics. If their parathyroid hormone levels remain elevated despite this treatment, surgery may be recommended.

After parathyroidectomy, the patient may experience improved calcium and phosphate levels, bone mineral density, and quality of life. However, there are risks associated with the surgery, including a higher hospitalization rate in the first year after surgery and the possibility of developing hungry bone syndrome.

Overall, parathyroidectomy can offer significant benefits for patients with secondary hyperparathyroidism that does not respond to medication, but it is important to weigh the risks and benefits with a healthcare provider.

What to Ask Your Doctor

  1. What are the potential benefits of undergoing a parathyroidectomy for my secondary hyperparathyroidism?

  2. What are the risks and potential complications associated with parathyroidectomy surgery?

  3. How will my calcium and phosphate levels be monitored and managed after the surgery?

  4. What is the expected recovery time and postoperative care plan following a parathyroidectomy?

  5. Are there any alternative treatment options available for my secondary hyperparathyroidism that should be considered before undergoing surgery?

  6. How many parathyroidectomy surgeries have you performed, and what is your success rate with this procedure?

  7. What are the long-term outcomes and prognosis for patients who undergo a parathyroidectomy for secondary hyperparathyroidism?

  8. Will I need to continue taking any medications or undergo additional treatments after the surgery to manage my condition?

  9. How often will I need to follow up with you or a specialist after the surgery to monitor my condition and hormone levels?

  10. Are there any lifestyle changes or dietary recommendations that I should follow to support my recovery and overall health after a parathyroidectomy?

Reference

Authors: Lau WL, Obi Y, Kalantar-Zadeh K. Journal: Clin J Am Soc Nephrol. 2018 Jun 7;13(6):952-961. doi: 10.2215/CJN.10390917. Epub 2018 Mar 9. PMID: 29523679