Our Summary

The research is about a medical condition called primary hyperparathyroidism (pHPT), which can only be cured through surgery. The study aimed to create a set of guidelines to help doctors treat patients with pHPT in the safest and most effective way.

To do this, a group of experts looked at medical research published between January 1985 and July 2015. They used a widely recognized system to rate the quality of the evidence they found.

The team found that patients with pHPT should undergo a series of tests, including 25-hydroxyvitamin D measurement, 24-hour urine calcium measurement, and dual-energy x-ray absorptiometry, and receive supplements if they have vitamin D deficiency. Surgery to remove the parathyroid gland is recommended for all patients showing symptoms and most patients without symptoms, as it’s more cost-effective than other treatments.

Before surgery, doctors should use imaging techniques to plan the operation. Even if imaging doesn’t locate the parathyroid gland, surgery can still proceed. Biopsies before surgery are not recommended. Surgeons who perform many of these operations have better results.

Both minimally invasive surgery and traditional surgery have high success rates. For minimally invasive surgery, it’s recommended to monitor the parathyroid hormone during the operation. This type of surgery is not recommended for patients with disease in multiple glands.

Doctors should also check for thyroid disease before surgery and deal with it during the operation if necessary. After surgery, patients should be watched for complications, tested for low calcium levels, and followed up to check the surgery was successful. They may need to take calcium supplements.

Lastly, the research notes that family-related pHPT, repeat surgeries, and parathyroid cancer are more complex cases that require special attention and expertise.

FAQs

  1. What tests are recommended for patients with primary hyperparathyroidism (pHPT) and why?
  2. What factors determine whether a patient should undergo traditional or minimally invasive surgery for pHPT?
  3. What are the post-surgery procedures and follow-ups for patients who have undergone surgery for pHPT?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to make sure to follow all pre- and post-operative instructions provided by the medical team. This may include fasting before surgery, stopping certain medications, and taking calcium supplements after the procedure. It’s important to communicate openly with your healthcare providers and attend all follow-up appointments to ensure a smooth recovery process.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with primary hyperparathyroidism who are experiencing symptoms such as kidney stones, osteoporosis, bone fractures, or high calcium levels in the blood. Patients without symptoms may also be recommended for surgery if they have certain risk factors, such as younger age, higher calcium levels, or kidney stones. Patients with recurrent or familial primary hyperparathyroidism, as well as those with parathyroid cancer, may also be recommended for surgery.

Timeline

Before parathyroidectomy:

  1. Patient experiences symptoms such as fatigue, bone pain, kidney stones, and other complications caused by primary hyperparathyroidism.
  2. Undergoes a series of tests to diagnose the condition, including blood tests and imaging techniques.
  3. Preparation for surgery, which may include receiving supplements if deficient in vitamin D.
  4. Imaging techniques used to plan the operation.
  5. Surgery to remove the parathyroid gland, either through minimally invasive or traditional surgery.

After parathyroidectomy:

  1. Patients are monitored for complications post-surgery.
  2. Checked for low calcium levels and may need to take calcium supplements.
  3. Follow-up to ensure the surgery was successful.
  4. Watched for thyroid disease and treated during the operation if necessary.
  5. Special attention needed for complex cases such as family-related pHPT, repeat surgeries, and parathyroid cancer.

What to Ask Your Doctor

Some questions a patient should ask their doctor about parathyroidectomy include:

  1. What tests will I need to undergo before the surgery?
  2. Will I need to take any supplements or medications before the surgery?
  3. What imaging techniques will be used to plan the operation?
  4. What are the potential risks and complications associated with the surgery?
  5. Will I need calcium supplements after the surgery?
  6. How long is the recovery period after the surgery?
  7. How will my calcium levels be monitored post-surgery?
  8. What signs or symptoms should I watch out for after the surgery?
  9. Will I need to follow up with you after the surgery, and if so, how often?
  10. Are there any specific lifestyle changes I should make post-surgery to support my recovery?

Reference

Authors: Wilhelm SM, Wang TS, Ruan DT, Lee JA, Asa SL, Duh QY, Doherty GM, Herrera MF, Pasieka JL, Perrier ND, Silverberg SJ, Solórzano CC, Sturgeon C, Tublin ME, Udelsman R, Carty SE. Journal: JAMA Surg. 2016 Oct 1;151(10):959-968. doi: 10.1001/jamasurg.2016.2310. PMID: 27532368