Our Summary

This research paper discusses a condition called Tertiary Hyperparathyroidism (HPT III). This typically happens when the parathyroid glands in our body produce too much parathyroid hormone (PTH), often as a result of a long-term issue with secondary hyperparathyroidism. This condition is commonly seen in people who have had chronic kidney disease for a long time. This disease can cause other issues in the body, like high levels of phosphorus in the blood, lack of a hormone called calcitriol, and low levels of calcium - all of which can increase the production of PTH.

When the parathyroid glands produce too much PTH, they can grow bigger than normal and continue to produce excessive PTH even after kidney transplantation has resolved the primary kidney disease. These enlarged glands may not respond well to certain treatments.

The main reasons to treat HPT III are persistent high levels of calcium and/or PTH in the body. The primary treatment is surgery, where the overactive parathyroid glands are removed. There are three types of surgeries that can be done: removing all the parathyroid glands, removing most of them, or removing only a limited number of them. Sometimes, parts of the thymus (a small organ in your chest) also need to be removed. However, the best type of surgery to use is still a topic of debate.

The good news is that these surgical procedures are generally safe and feasible treatment options for HPT III, and complications are rare.

FAQs

  1. What is tertiary hyperparathyroidism and what causes it?
  2. What are the common surgical procedures performed to treat tertiary hyperparathyroidism?
  3. What are the potential complications of parathyroidectomy surgery?

Doctor’s Tip

One helpful tip a doctor might tell a patient about parathyroidectomy is to follow post-operative care instructions carefully, including taking prescribed medications, attending follow-up appointments, and monitoring calcium levels regularly. It is important to communicate any symptoms or concerns to your healthcare provider to ensure a successful recovery.

Suitable For

Patients who are typically recommended for parathyroidectomy include those with tertiary hyperparathyroidism (HPT III) resulting from longstanding chronic kidney disease (CKD) or persistent hyperparathyroidism after successful renal transplantation. These patients may have symptoms of hypercalcemia and/or increased parathyroid hormone (PTH) levels despite normal or elevated serum calcium levels. Surgical intervention may be necessary to correct the metabolic disturbances and alleviate symptoms.

Timeline

Before parathyroidectomy:

  • Patient may have longstanding chronic kidney disease leading to metabolic disturbances such as hyperphosphatemia, calcitriol deficiency, and hypocalcemia
  • Increased secretion of parathyroid hormone (PTH) leading to nodular hyperplasia and excess PTH secretion
  • Persistent hypercalcemia and/or increased PTH levels despite correction of primary disorder through renal transplant
  • Treatment with medications such as calcimimetics may be ineffective
  • Surgery recommended as primary treatment

After parathyroidectomy:

  • Three common procedures: total parathyroidectomy with or without autotransplantation, subtotal parathyroidectomy, and limited parathyroidectomy
  • Removal of superior parts of thymus may also be necessary
  • Surgical complications rare, procedure considered safe and feasible
  • Resolution of hypercalcemia and excess PTH secretion expected post-surgery

What to Ask Your Doctor

  1. What is the reason for recommending a parathyroidectomy in my case?

  2. What are the potential risks and complications associated with the surgery?

  3. How experienced are you in performing parathyroidectomy procedures?

  4. Will I need to take any medications or follow a specific diet after the surgery?

  5. What is the expected recovery time and are there any restrictions on activities during the recovery period?

  6. How will my calcium and PTH levels be monitored post-surgery?

  7. What are the chances of the hyperparathyroidism returning after the surgery?

  8. Are there any alternative treatment options for my condition?

  9. How long will I need to follow up with you after the surgery?

  10. Can you explain the different types of parathyroidectomy procedures and why one may be recommended over another in my case?

Reference

Authors: Palumbo VD, Palumbo VD, Damiano G, Messina M, Fazzotta S, Lo Monte G, Lo Monte AI. Journal: Clin Ter. 2021 May 5;172(3):241-246. doi: 10.7417/CT.2021.2322. PMID: 33956045