Our Summary

The research paper is about patients who have had to have a second parathyroidectomy - a surgery to remove the parathyroid glands that control calcium levels in the body - due to ongoing or returning hyperparathyroidism, a condition where these glands produce too much hormone, leading to high calcium levels. The researchers wanted to find out how many imaging studies - or scans - are needed before this second surgery to locate the glands.

Between 2001 and 2019, they studied 251 patients who had this second surgery. They divided these patients into four groups, depending on how many scans they had before their surgery: no scans, one scan, two scans, or three scans.

The researchers found that 97% of these surgeries were successful, regardless of how many scans were done before the surgery. Interestingly, most patients only had one or no scans before their surgery, and yet almost all of them were successfully treated.

So, the authors conclude that a successful second parathyroidectomy can be performed with few or even no scans beforehand, in certain situations.

FAQs

  1. What is a re-operative parathyroidectomy and why might it be needed?
  2. How does the number of positive localization studies affect the success rate of re-operative parathyroidectomy?
  3. What range of pre-operative scans are typically involved in re-operative parathyroidectomy procedures?

Doctor’s Tip

A helpful tip a doctor might tell a patient about parathyroidectomy is to trust in the expertise of the surgical team, as successful re-operative parathyroidectomy can be achieved with minimal pre-operative scans in certain clinical contexts. It is important to follow the post-operative care instructions provided by your healthcare provider to ensure a smooth recovery and optimal outcome.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with recurrent or persistent hyperparathyroidism. These patients may have undergone previous unsuccessful parathyroidectomy or have persistent symptoms despite medical management. In some cases, patients may have a high calcium level or symptoms such as bone pain, kidney stones, or fatigue that are not improving with conservative management. Additionally, patients with a confirmed diagnosis of primary hyperparathyroidism, as indicated by elevated levels of parathyroid hormone and calcium, may also be recommended for parathyroidectomy.

Timeline

Before Parathyroidectomy:

  • Patient experiences symptoms of hyperparathyroidism such as fatigue, weakness, bone pain, and kidney stones.
  • Patient undergoes blood tests to confirm elevated levels of parathyroid hormone and calcium.
  • Patient may undergo imaging studies such as ultrasound, sestamibi scan, or CT scan to localize the abnormal parathyroid gland.
  • Patient consults with an endocrine surgeon to discuss the surgical procedure and potential risks.

After Parathyroidectomy:

  • Patient undergoes the surgical procedure to remove the abnormal parathyroid gland.
  • Patient may stay in the hospital for observation and recovery.
  • Patient may experience temporary hoarseness or difficulty swallowing due to the proximity of the surgery to the vocal cords.
  • Patient’s calcium levels are monitored closely to ensure they remain within normal range.
  • Patient follows up with the surgeon for post-operative care and monitoring of symptoms.

Overall, successful re-operative parathyroidectomy can be performed with minimal pre-operative scans in certain clinical contexts, with a high cure rate and minimal complications.

What to Ask Your Doctor

  1. What is the reason for recommending a parathyroidectomy?
  2. How many localization studies will be done before the surgery?
  3. What are the potential risks and complications of a parathyroidectomy?
  4. What is the success rate of re-operative parathyroidectomy in patients with recurrent or persistent hyperparathyroidism?
  5. What is the recovery process like after a parathyroidectomy?
  6. Will I need to take any medications or make any lifestyle changes after the surgery?
  7. How long will it take for me to see the effects of the surgery on my symptoms?
  8. Are there any alternative treatments to a parathyroidectomy that I should consider?
  9. How often will I need follow-up appointments after the surgery?
  10. Are there any long-term effects or complications that I should be aware of after having a parathyroidectomy?

Reference

Authors: Ramonell KM, Chen H, Lindeman B, Fazendin J. Journal: Am J Surg. 2021 Feb;221(2):485-488. doi: 10.1016/j.amjsurg.2020.11.027. Epub 2020 Nov 17. PMID: 33220935