Changes in secondary hyperparathyroidism-related biochemical parameters and medication use following parathyroidectomy

Abstract

While PTH levels dropped after parathyroidectomy for most patients, surgery was sometimes ineffective in reducing levels and sometimes led to over-suppression. Hypocalcemia could be profound and long lasting, suggesting the need for prolonged vigilance.

Targeted surgical parathyroidectomy in end‐stage renal disease patients and long‐term metabolic control: A single‐center experience in the current era

“…Some patients will inevitably have a recurrence, which shall not be a reason to expose all patients to an excessive surgical gland removal. On the other hand, except early after surgery, hyperphosphatemia recurred and persisted in the cohort, similarly to what a recent paper discloses referring to a nationwide sample . Although relevant data were not collected, we know from our patient care experience that all of these patients had received vigorous amounts of VDA (our dialysis unit used almost exclusively I.V.…”

Geographic variation of parathyroidectomy in patients receiving hemodialysis: a retrospective cohort analysis

“…Practice guidelines provide direction [4] but suffer from lack of randomized clinical trial data, resulting in uncertainty about the benefits and risks of parathyroidectomy. Understanding use of parathyroidectomy is important, given widely varying recent data demonstrating both clinical benefits [5, 6], as well as high rates of adverse events and suboptimal mineral metabolic outcomes [7, 8]. Our large retrospective analysis demonstrated substantial geographic variation in parathyroidectomy use.…”

“…Given recent information about the potential risks associated with parathyroidectomy [7, 8], the factors responsible for shaping the decision to undertake it should also be the subject of future investigation.…”

“…While guidelines recommend parathyroidectomy in patients with severe SHPT [4], how it might be used most optimally is uncertain. Parathyroidectomy has been shown to be associated with improved outcomes in some studies [5, 6]; however, it has also been shown to be associated with mortality, protracted hypocalcemia, and over-suppression of parathyroid hormone (PTH) [7], and its results with regard to mineral metabolic control are often suboptimal [8]. Thus, understanding the differences between hemodialysis patients who do and do not undergo parathyroidectomy may be important.…”

Parathyroidectomy: Complex Decisions about a Complex Procedure

“…A nontrivial 2% mortality rate in the month after PTX was reported using data from a large national dialysis provider (20). Second, PTX, which undoubtedly reduces PTH levels enormously in most patients, seems to fail in a surprisingly large subset, and hypocalcemia remains a substantial problem in many patients even 6-12 months after surgery (21). These findings likely diminish enthusiasm for PTX.…”