Our Summary

Secondary hyperparathyroidism (SHPT) is a significant issue for patients with chronic kidney disease, leading to problems such as bone disease, fractures, and heart disease. Treatment for this condition has evolved with the introduction of drugs called calcimimetics, but surgery to remove the parathyroid glands (PTx) is still a key treatment approach. Successful PTx requires all parathyroid glands to be removed without complications to avoid ongoing or recurring SHPT. Various techniques, including imaging studies and intraoperative evaluations, are used to locate the parathyroid glands and confirm their complete removal. The surgical technique chosen must consider the patient’s potential need for a kidney transplant. In cases where SHPT continues or returns after the first PTx, finding the problematic glands can be difficult as they can be located in various areas. Lastly, the effectiveness and cost-efficiency of calcimimetics and PTx are topics of ongoing discussion. This paper reviews the medical and surgical treatments for SHPT.

FAQs

  1. What is secondary hyperparathyroidism and how is it related to chronic kidney disease?
  2. What are the different techniques used to locate and remove parathyroid glands during a parathyroidectomy?
  3. What is the role of calcimimetics in the treatment of secondary hyperparathyroidism and how do they compare to parathyroidectomy in terms of effectiveness and cost-efficiency?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to follow all pre-operative instructions provided by the surgical team, including fasting guidelines and medication management. It is also important to discuss any concerns or questions with your healthcare team before the surgery. After the procedure, follow post-operative care instructions carefully, including taking prescribed medications and attending follow-up appointments. It is important to monitor calcium levels and symptoms closely after surgery and report any changes to your healthcare provider promptly. Additionally, maintaining a healthy lifestyle, including a balanced diet and regular exercise, can help support overall healing and recovery after parathyroidectomy.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with:

  1. Primary hyperparathyroidism: This condition is caused by a benign tumor on one or more of the parathyroid glands, leading to overproduction of parathyroid hormone (PTH) and elevated calcium levels in the blood. Symptoms may include bone pain, kidney stones, fatigue, and digestive issues.

  2. Secondary hyperparathyroidism in patients with chronic kidney disease: Patients with CKD often develop SHPT due to imbalances in calcium, phosphorus, and vitamin D metabolism. Parathyroidectomy may be recommended if medical treatment with calcimimetics or vitamin D analogs is inadequate in controlling PTH levels.

  3. Tertiary hyperparathyroidism: This rare condition occurs when SHPT persists or recurs after a kidney transplant. Parathyroidectomy may be necessary to prevent complications such as hypercalcemia and bone disease.

  4. Severe symptoms or complications: Parathyroidectomy may be recommended for patients with severe symptoms such as osteoporosis, kidney stones, heart disease, or neurological symptoms related to hyperparathyroidism.

  5. Inadequate response to medical treatment: If medications or other non-surgical treatments fail to control PTH levels or symptoms, parathyroidectomy may be considered as a more definitive treatment option.

Overall, the decision to recommend parathyroidectomy is based on the severity of the patient’s symptoms, the underlying cause of hyperparathyroidism, and the potential risks and benefits of surgery. A thorough evaluation by a multidisciplinary team including endocrinologists, nephrologists, and surgeons is important in determining the most appropriate treatment approach for each individual patient.

Timeline

Before parathyroidectomy:

  1. Patient is diagnosed with secondary hyperparathyroidism (SHPT) due to chronic kidney disease.
  2. Patient may experience symptoms such as bone pain, fractures, and cardiovascular issues.
  3. Treatment options are discussed, including medication with calcimimetics or surgical removal of the parathyroid glands (PTx).
  4. Pre-operative evaluations are conducted to assess the patient’s overall health and determine the best approach for surgery.

After parathyroidectomy:

  1. Patient undergoes parathyroidectomy surgery to remove the overactive parathyroid glands.
  2. Post-operative care is provided to monitor the patient’s recovery and manage any potential complications.
  3. Patient may experience a decrease in symptoms related to SHPT, such as bone pain and cardiovascular issues.
  4. Follow-up appointments are scheduled to monitor the patient’s calcium levels and overall health post-surgery.
  5. Patient may require ongoing treatment with calcium and vitamin D supplements to maintain proper calcium levels in the body.

What to Ask Your Doctor

  1. What are the potential risks and complications associated with a parathyroidectomy procedure?
  2. How will the success of the surgery be evaluated, and what follow-up care will be necessary?
  3. How long is the recovery period after a parathyroidectomy, and what restrictions or lifestyle changes will be necessary during this time?
  4. Are there any alternative treatment options to consider before opting for surgery?
  5. How likely is it that I will need a second parathyroidectomy in the future, and what factors could contribute to this?
  6. Will removing the parathyroid glands affect my overall calcium levels and bone health in the long term?
  7. How will the surgery impact my eligibility for a kidney transplant, if that becomes necessary in the future?
  8. What imaging studies or tests will be used to locate the parathyroid glands before surgery, and how accurate are these techniques?
  9. How does the cost of a parathyroidectomy compare to ongoing treatment with calcimimetics, and what factors should be considered when making this decision?
  10. Are there any specific dietary or medication instructions I should follow before and after the surgery to optimize the outcome?

Reference

Authors: Hiramitsu T, Hasegawa Y, Futamura K, Okada M, Goto N, Narumi S, Watarai Y, Tominaga Y, Ichimori T. Journal: Front Endocrinol (Lausanne). 2023 Apr 20;14:1169793. doi: 10.3389/fendo.2023.1169793. eCollection 2023. PMID: 37152972