Hyperparathyroidism Secondary to Chronic Kidney Disease
The parathyroids are four rice grain sized glands located in the neck, attached behind the thyroid gland that produce parathyroid hormone (PTH) which controls calcium levels in the blood. PTH helps maintain an appropriate balance of calcium in the bloodstream and in tissues that depend on calcium to be able to function properly. An excess of this hormone is caused by hyperactivity of the glands and is known as hyperparathyroidism. When the hyperactivity of the hormone is caused by hyperactivity of the glands and is known as hyperparathyroidism. When the hyperactivity of the glands and an increase in PTH levels are caused by another disease, it is called secondary hyperparathyroidism.
One of the leading causes of secondary hyperparathyroidism in chronic kidney disease. The disorder causes complexity of calcium and phosphate metabolism which results in increased blood levels. Due to the breakdown of the bone. Prolonged high levels of calcium and phosphate may result in a number of complications most commonly involving the bone. Osteomalacia or softening of the bones and osteoporosis may develop and can be seen as bone deformities, swollen joints or fractures. Other complications include calcification or hardening of blood vessels and organs, decrease in heart function, decreased immunity, and anemia amongst others. Simple blood tests can be diagnosed if a patient already has secondary hyperparathyroidism with elevated intact PTH.
The first line of treatment includes medications to control blood levels of calcium and phosphate. However, if the intact PTH level is persistently high despite maximal medications or if the size of one gland is >500mm3; surgical removal of the parathyroid glands is indicated for better control of calcium metabolism.
Total parathyroidectomy is the surgical removal of all parathyroid glands. The procedure is done selectively and will require hospital admission for a few days. The patient’s clinical status needs to be optimized. Immediately after surgery, the intact PTH level is tested and is expected to drastically decrease. Calcium levels will also be expected to immediately decrease and is corrected with medications. The patient is discharged about three to five days after the surgery and followed up at the clinic after one week.
Providence Hospital Inc. works with a team who is experienced and knowledgeable in these cases. The institute is also equipped with the proper tools and equipment to successfully manage secondary hyperparathyroidism both medically and surgically. The entire perioperative course of each patient is individualized to cater to specific needs. Successful parathyroidectomy is important management to control the blood levels of phosphorus and calcium. This results in improved bone density, the lessened incidence of fractures, and decreased number of cardiovascular disease death. More importantly, it not only increases the patient’s chances of survival but also improves quality of life.
Michelle Bernadette C. Lim-Loo, RMT, MD, FPSGS, FPCS
Bariatric and Metabolic Surgery
General, Cancer and Laparoscopic Surgery
Education and Training:
Body Science and Metabolic Disorders International Medical Center
Bariatric and Metabolic Surgery Fellowship at China Medical University Hospital, Taiwan
General Surgery Residency Training at Chinese General Hospital and Medical Center
Doctor of Medicine at the University of St. Tom
Post Graduate Training:
Intensive Course in Laparoscopic General Surgery at Asia IRCAD – Taiwan