Our Summary

This study looked at whether a total removal or a partial removal of the parathyroid glands (a type of surgery) was better for patients with secondary hyperparathyroidism who are on kidney replacement therapy. The researchers used data from Swedish national health registries to find patients who had this surgery between 1991 and 2013, and they took into account factors like the patients’ age, sex, cause of kidney disease, how long they had a functioning graft before and after the surgery, other health conditions, year of surgery, existing heart disease, time on dialysis, whether they had a kidney transplant at the time of the parathyroid surgery, and whether they were being treated with a type of medication called calcimimetics before the surgery.

They found that there was no difference in death rates or the risk of breaking a hip between the two groups. However, they found that patients who had a total parathyroid removal had a higher risk of heart-related issues but a lower risk of needing another parathyroid surgery compared to those who had a partial removal.

FAQs

  1. What was the purpose of the study on parathyroidectomy and secondary hyperparathyroidism?
  2. What factors were taken into account in the research on total versus partial parathyroid removal?
  3. What were the significant findings of the study comparing total and partial parathyroid removal in patients with secondary hyperparathyroidism?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to discuss with them the potential risks and benefits of a total versus a partial removal of the parathyroid glands. It is important to weigh the risks of heart-related issues against the risk of needing another surgery in the future. Additionally, patients should be informed about the importance of closely monitoring their calcium levels post-surgery and following up with their healthcare provider regularly.

Suitable For

Parathyroidectomy is typically recommended for patients suffering from hyperparathyroidism, a condition characterized by an overactive parathyroid gland which leads to excessive calcium in the blood. More specifically, this study focused on patients with secondary hyperparathyroidism, a condition often associated with kidney disease. Patients on kidney replacement therapy or dialysis are common candidates for this surgery. Other potential candidates include those with existing heart disease or those who have had a kidney transplant. Additionally, patients who have not responded to or cannot tolerate medication treatments, like calcimimetics, might also be recommended for parathyroidectomy.

Timeline

Before the parathyroidectomy:

  1. Patient is diagnosed with secondary hyperparathyroidism while on kidney replacement therapy.
  2. Patient is evaluated for surgery and potential risks and benefits are discussed.
  3. Pre-operative testing is done to assess the patient’s overall health and suitability for surgery.
  4. Surgery is scheduled and patient is informed about what to expect during and after the procedure.

After the parathyroidectomy:

  1. Patient undergoes the surgery, either a total or partial removal of the parathyroid glands.
  2. Post-operative care is provided to manage pain, monitor for complications, and ensure proper healing.
  3. Patient may need to make lifestyle changes or take medications to manage calcium levels and prevent complications.
  4. Follow-up appointments are scheduled to monitor the patient’s progress and adjust treatment as needed.
  5. Long-term monitoring is done to assess the effectiveness of the surgery and manage any ongoing issues related to secondary hyperparathyroidism.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a parathyroidectomy surgery?
  2. How will this surgery impact my kidney function and overall health as a patient on kidney replacement therapy?
  3. What are the differences between a total parathyroid removal and a partial removal in terms of long-term outcomes and potential complications?
  4. How will the surgery affect my calcium levels and bone health?
  5. Is there a chance that I may need additional parathyroid surgeries in the future?
  6. How long is the recovery process after a parathyroidectomy surgery?
  7. What are the alternative treatment options available for managing secondary hyperparathyroidism?
  8. Will I need to make any lifestyle changes or adjustments post-surgery?
  9. How often will I need follow-up appointments and monitoring after the surgery?
  10. Are there any specific dietary or medication instructions I should follow before and after the surgery?

Reference

Authors: Isaksson E, Ivarsson K, Akaberi S, Muth A, Prütz KG, Clyne N, Sterner G, Almquist M. Journal: Surgery. 2019 Jan;165(1):142-150. doi: 10.1016/j.surg.2018.04.076. Epub 2018 Nov 7. PMID: 30413319