Our Summary

This research paper looks at two types of surgery for a condition called secondary hyperparathyroidism, which is often seen in patients on dialysis. The condition is generally treated with a surgery called parathyroidectomy (PTx), and the two types discussed in the study are total PTx with autotransplantation and subtotal PTx.

The researchers were particularly interested in seeing how often patients had low calcium levels (hypocalcemia) after surgery, which can cause problems. They looked at records of 143 patients who had PTx at their hospital between 2010 and 2021.

They found that patients who had the subtotal PTx were less likely to have low calcium levels after surgery and also had a shorter hospital stay. They also required less calcium supplementation a month after their surgery. The success rate of the surgery was similar for both groups.

Statistical analysis showed that patients who had the total PTx with autotransplantation were nearly 12 times more likely to have problems with low calcium levels after surgery, stayed in hospital about a day longer, and needed more calcium supplementation.

In conclusion, the researchers found that subtotal PTx leads to fewer problems with low calcium levels after surgery, while still being as effective, for patients on dialysis with secondary hyperparathyroidism.

FAQs

  1. What is secondary hyperparathyroidism and how is it typically treated?
  2. What were the main findings of the study comparing total PTx with autotransplantation and subtotal PTx?
  3. Why are low calcium levels a concern after parathyroidectomy?

Doctor’s Tip

A helpful tip a doctor might give to a patient about parathyroidectomy is to discuss with them the benefits of subtotal PTx compared to total PTx with autotransplantation, especially for those on dialysis with secondary hyperparathyroidism. Subtotal PTx may lead to fewer issues with low calcium levels after surgery, a shorter hospital stay, and less need for calcium supplementation. It is important for patients to be informed about their surgical options and to work closely with their healthcare team to determine the best treatment plan for their individual needs.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with primary hyperparathyroidism, secondary hyperparathyroidism, and tertiary hyperparathyroidism. Primary hyperparathyroidism is usually caused by a benign tumor on one of the parathyroid glands, leading to excess production of parathyroid hormone (PTH) and elevated calcium levels in the blood. Secondary hyperparathyroidism is often seen in patients with chronic kidney disease or on dialysis, where the parathyroid glands overproduce PTH in response to low calcium levels. Tertiary hyperparathyroidism occurs when secondary hyperparathyroidism becomes autonomous and no longer responds to changes in calcium levels.

Patients with symptoms of hyperparathyroidism such as fatigue, bone pain, kidney stones, and fractures may be recommended for parathyroidectomy. Additionally, patients with severe complications of hyperparathyroidism such as osteoporosis, kidney damage, or cardiovascular issues may also be candidates for surgery.

Overall, the decision to recommend parathyroidectomy for a patient will depend on their individual symptoms, medical history, and the underlying cause of their hyperparathyroidism. It is important for patients to discuss the risks and benefits of surgery with their healthcare provider to determine the best course of treatment for their specific condition.

Timeline

Before parathyroidectomy:

  • Patient likely experiences symptoms of secondary hyperparathyroidism, such as bone pain, fatigue, weakness, and kidney problems.
  • Patient undergoes preoperative testing to determine the extent of the condition and assess overall health.
  • Patient may receive medications or other treatments to manage symptoms before surgery.

After parathyroidectomy:

  • Patient undergoes surgery to remove the overactive parathyroid glands.
  • Recovery period begins, during which the patient may experience temporary low calcium levels (hypocalcemia) and may require calcium supplementation.
  • Patient is monitored closely for any complications or side effects of the surgery.
  • Over time, symptoms of secondary hyperparathyroidism should improve as the body adjusts to the surgery and the parathyroid hormone levels normalize.

What to Ask Your Doctor

  1. What is the difference between total PTx with autotransplantation and subtotal PTx?
  2. What are the potential risks and complications associated with parathyroidectomy surgery?
  3. How likely am I to experience low calcium levels after surgery, and what symptoms should I watch out for?
  4. How long is the recovery period after parathyroidectomy surgery?
  5. Will I need to take calcium supplements after surgery, and for how long?
  6. How will parathyroidectomy surgery impact my kidney function, especially since I am already on dialysis?
  7. What is the success rate of parathyroidectomy surgery for patients with secondary hyperparathyroidism?
  8. How will my quality of life be affected after parathyroidectomy surgery?
  9. Are there any alternative treatments or medications I should consider before opting for surgery?
  10. How often will I need to follow up with you after the surgery for monitoring and evaluation?

Reference

Authors: Wang R, Disharoon M, Frazier R, Xie R, Moses C, Gillis A, Fazendin J, Lindeman B, Gutierrez OM, Chen H. Journal: J Am Coll Surg. 2023 Apr 1;236(4):639-645. doi: 10.1097/XCS.0000000000000539. Epub 2023 Jan 5. PMID: 36728468