Our Summary

This research paper is about a 60-year-old African American man with serious kidney disease who was treated with hemodialysis for about 2.5 years. He developed an extreme case of hyperparathyroidism, a condition where the parathyroid glands produce too much parathyroid hormone. Despite being on medication, his parathyroid hormone levels were extremely high. He had surgery to remove most of his parathyroid glands, which initially lowered these hormone levels.

However, a month after surgery, he developed painful, decaying skin sores on his lower body, a sign of a serious condition called calciphylaxis. This condition involves the calcification of blood vessels in the skin and fatty tissue, and it’s a dangerous complication of advanced kidney disease. The patient’s calciphylaxis was confirmed by a tissue biopsy.

The patient received extensive wound care, increased dialysis, and a specific treatment called sodium thiosulfate during his dialysis sessions. He also received several types of medication for pain control. Although his sores initially improved, his overall health deteriorated due to recurring infections, respiratory failure, and long hospital stays. He eventually had to stop his dialysis treatments and later passed away.

This case is unique because the patient developed calciphylaxis after surgery to remove most of his parathyroid glands. The authors of the paper suspect this happened because his parathyroid hormone levels dropped, leading to a decrease in bone turnover and thus, more circulating calcium. This excess calcium might have contributed to the calcification of his blood vessels and soft tissues. The exact cause, however, is unknown.

Even though surgery to remove the parathyroid glands can effectively treat calciphylaxis, this case shows that it might also lead to calciphylaxis in rare instances. The authors suggest that doctors should be aware of this potential complication.

FAQs

  1. What is hyperparathyroidism and how is it related to kidney disease?
  2. What is calciphylaxis and how is it treated?
  3. Can parathyroidectomy lead to calciphylaxis? How can doctors prevent this complication?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to closely monitor their calcium levels post-surgery to prevent complications such as calciphylaxis. It is important for patients to follow up with their healthcare provider regularly and report any concerning symptoms or changes in their condition. Additionally, patients should adhere to their prescribed treatment plan and medications to manage their calcium levels effectively.

Suitable For

Patients who are typically recommended parathyroidectomy are those with primary hyperparathyroidism, secondary hyperparathyroidism, or tertiary hyperparathyroidism. Primary hyperparathyroidism occurs when one or more of the parathyroid glands become enlarged and produce too much parathyroid hormone, leading to high levels of calcium in the blood. Secondary hyperparathyroidism occurs as a result of another underlying condition, such as chronic kidney disease, which leads to elevated parathyroid hormone levels. Tertiary hyperparathyroidism occurs when secondary hyperparathyroidism progresses to a state of autonomous parathyroid gland function.

Patients with severe symptoms such as bone pain, fractures, kidney stones, or high calcium levels in the blood are often recommended for parathyroidectomy. Additionally, patients who do not respond to medical treatment or have complications such as calciphylaxis, as seen in the case described above, may also be candidates for surgery. It is important for healthcare providers to carefully assess each patient’s individual situation and recommend the appropriate treatment option based on their specific needs and circumstances.

Timeline

  • Patient experiences extreme hyperparathyroidism with high levels of parathyroid hormone
  • Patient undergoes parathyroidectomy surgery to remove most of his parathyroid glands
  • One month post-surgery, patient develops painful, decaying skin sores on lower body
  • Patient is diagnosed with calciphylaxis, a serious complication of advanced kidney disease
  • Patient receives wound care, increased dialysis, sodium thiosulfate treatment, and pain medication
  • Patient’s sores initially improve but overall health deteriorates due to recurring infections and respiratory failure
  • Patient stops dialysis treatments and eventually passes away

Overall, the patient’s experience before and after parathyroidectomy involved a complex series of events, including the development of a serious complication that ultimately led to his death. The case highlights the importance of monitoring patients post-surgery for potential complications, even if the surgery is initially successful in treating the underlying condition.

What to Ask Your Doctor

  1. What is hyperparathyroidism and why did I need a parathyroidectomy?
  2. What are the risks and benefits of a parathyroidectomy in my case?
  3. What are the potential complications of a parathyroidectomy, including rare complications like calciphylaxis?
  4. How will my parathyroid hormone levels be monitored after surgery?
  5. What symptoms should I watch out for that may indicate complications like calciphylaxis?
  6. What treatment options are available if complications arise after the surgery?
  7. How will my overall kidney health be monitored and managed after the parathyroidectomy?
  8. Are there any lifestyle changes or medications I should consider to reduce my risk of complications after surgery?
  9. How long is the recovery process after a parathyroidectomy, and what should I expect during this time?
  10. Are there any additional tests or follow-up appointments I should schedule to monitor my health post-surgery?

Reference

Authors: Karmegam S, Shetty A. Journal: Hemodial Int. 2017 Oct;21 Suppl 2:S62-S66. doi: 10.1111/hdi.12599. PMID: 29064176