Delayed Calcium Normalization after Successful Parathyroidectomy in Primary Hyperparathyroidism

Abstract

Introduction. Parathyroidectomy is the curative treatment option in primary hyperparathyroidism (PHPT). The decrease of parathormone (PTH) by 50% or more from levels prior to surgery after excision predicts successful parathyroidectomy. Serum calcium is expected to return to normal within 24–72 hours after the surgery; however, nearly 10% have transient, persistent postoperative hypercalcemia. We present a case report of delayed calcium normalization after successful parathyroidectomy in a 38-year-old patient with PHPT. Methods. Parathyroidectomy was performed, with evidence of a decrease in PTH levels of more than 50% in the first 24 hours postoperatively compared to presurgical PTH; however, despite curative parathyroidectomy, a delayed calcium normalization was evidenced, with hypercalcemia persistence up to 120 hours postoperatively. Results. After the first month postoperatively, serum calcium remained normal. In conclusion, approximately 10% of patients with curative parathyroidectomy have transient, persistent postoperative hypercalcemia, which is more likely to occur in patients with higher preoperative serum calcium and PTH levels. Conclusion. Persistent hypercalcemia after the first month postoperatively is related with persistent PHPT, highlighting the importance of calcium monitoring after parathyroidectomy to predict short-term, medium-term, and long-term outcomes and prognosis.

Reflections of the Anesthetic Management in a Case of Parathyroid Adenoma: A Case Report

“…Reduction of PTH levels by more than 50% of the preoperative levels, is suggestive optimal parathyroid removal [11]. In our case, PTH showed a significant decrease from its preoperative levels.…”

Hiperparatireoidismo Primário Por Adenoma De Paratireóide: Relato De Caso

“…(XAVIER, 2020). The reduction of serum PTH values by 50% or more compared to previous levels suggests that the parathyroidectomy was successful and serum calcium returns to normal value after 24 -72 hours (RODRIGUEZ et al, 2021). If surgery cannot be performed, clinical management is indicated (GUZMAN; ARIBA, 2021).…”

“…A paratireoidectomia é o tratamento padrão -ouro (XAVIER, 2020). A redução dos valores séricos do PTH em 50% ou mais em relação aos níveis anteriores sugere que a paratireoidectomia foi bem-sucedida e o cálcio sérico retorna ao valor normal após 24 -72 horas (RODRIGUEZ et al, 2021). Se a cirurgia não puder ser realizada, o manejo clínico é indicado (GUZMAN; ARIBA, 2021).…”