Our Summary

This research paper tells the story of a man who had a type of tumor called a parathyroid adenoma removed in 1987 when he was 21 years old. This condition caused a disease called primary hyperparathyroidism (PHPT), which he also had to treat two more times after the tumor returned. However, when he turned 52, he developed a condition called hypoparathyroidism (HP), which is usually a result of neck surgery but in this case occurred many years later.

The researchers investigated his case and reviewed other similar cases. They found that his blood calcium levels were lower than normal, and his parathyroid hormone (PTH) was also low. They ruled out other causes of his condition, such as genetic or autoimmune causes. Instead, they believe that his parathyroid glands, which control calcium levels in the body, have been damaged or have shrunk over time since his surgeries, leading to his low calcium levels.

Previously, all 19 reported cases of this late-onset HP occurred after thyroid surgery, but not after parathyroid removal, which makes his case unique. Therefore, the researchers recommend close follow-up of patients who have had multiple parathyroid surgeries, including regular checks of their calcium, phosphate, and PTH levels.

FAQs

  1. What is a parathyroid adenoma and how does it relate to primary hyperparathyroidism (PHPT)?
  2. What is hypoparathyroidism (HP) and why is it typically associated with neck surgeries?
  3. Why is it recommended for patients who have had multiple parathyroid surgeries to have regular checks of their calcium, phosphate, and PTH levels?

Doctor’s Tip

A helpful tip a doctor might tell a patient about parathyroidectomy is to closely monitor their calcium, phosphate, and parathyroid hormone levels after the surgery, especially if they have had multiple surgeries. Regular follow-up appointments and blood tests can help detect any potential complications, such as hypoparathyroidism, early on and allow for appropriate treatment.

Suitable For

Patients who are typically recommended for parathyroidectomy are those who have primary hyperparathyroidism (PHPT) caused by a parathyroid adenoma or hyperplasia. PHPT is characterized by elevated levels of calcium in the blood due to overactivity of the parathyroid glands. Symptoms of PHPT may include fatigue, weakness, kidney stones, bone pain, and gastrointestinal issues.

In some cases, patients may also develop complications such as osteoporosis, kidney damage, or pancreatitis. Parathyroidectomy is recommended for patients with severe symptoms, complications, or significantly elevated calcium levels that cannot be managed with medication or lifestyle changes.

Additionally, patients with secondary or tertiary hyperparathyroidism, which are often associated with chronic kidney disease or other underlying conditions, may also be recommended for parathyroidectomy if conservative treatments are ineffective.

Overall, the decision to undergo parathyroidectomy is based on individual patient factors, including symptoms, calcium levels, and overall health. It is important for patients to discuss their options with their healthcare provider to determine the best course of treatment for their specific condition.

Timeline

  • Before parathyroidectomy:
  1. Patient experiences symptoms of primary hyperparathyroidism (PHPT) such as fatigue, weakness, bone pain, kidney stones, and high levels of calcium in the blood.
  2. Patient undergoes diagnostic tests such as blood tests, imaging studies, and a sestamibi scan to locate the parathyroid adenoma.
  3. Patient undergoes parathyroidectomy surgery to remove the tumor and normalize calcium levels.
  • After parathyroidectomy:
  1. Patient experiences relief from symptoms of PHPT as calcium levels return to normal.
  2. Patient may need to take calcium and vitamin D supplements temporarily to support healing.
  3. Patient undergoes regular follow-up appointments to monitor calcium, phosphate, and parathyroid hormone levels.
  4. In some cases, such as the case mentioned in the research paper, patient may develop hypoparathyroidism (HP) years after the initial surgery, leading to low calcium levels and the need for long-term calcium and vitamin D supplementation.

What to Ask Your Doctor

  1. What are the potential risks and complications of a parathyroidectomy surgery?
  2. How long is the recovery period after a parathyroidectomy?
  3. Will I need to take any medications after the surgery? If so, what are they and for how long?
  4. How often will I need to have follow-up appointments to monitor my calcium levels post-surgery?
  5. Are there any dietary or lifestyle changes I should make after a parathyroidectomy?
  6. What are the signs and symptoms of hypoparathyroidism that I should watch out for after the surgery?
  7. Are there any specific factors that increase my risk of developing hypoparathyroidism after a parathyroidectomy?
  8. What are the treatment options for hypoparathyroidism if it occurs after the surgery?
  9. Are there any long-term complications or risks associated with hypoparathyroidism?
  10. How will the removal of the parathyroid glands affect my overall health and well-being in the long term?

Reference

Authors: Semeraro A, Kemp EH, Pardi E, Di Certo A, Marcocci C, Cetani F. Journal: Endocrine. 2020 Aug;69(2):402-409. doi: 10.1007/s12020-020-02344-y. Epub 2020 May 21. PMID: 32435983