275:. Despite the reactivation of unresected parathyroid glands producing normal to elevated levels of PTH, serum calcium continues to be low. The balance between calcium influx and efflux within the bone continues to be disrupted, favoring the former. The bone is said to be "hungry" as it consumes minerals without regard to PTH; calcium, magnesium, and phosphate continue to be deposited into the bones, resulting in hypocalcemia, hypomagnesemia, and hypophosphatemia. Prolonged calcium supplementation may be required. Hungry bone syndrome is particularly common in people who are on long-term regular dialysis.
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levels six months after treatment has started, thought to be autonomous production of hormone by the glands and loss of feedback mechanisms. In this situation surgical parathyroidectomy may be required, especially if calcium and phosphate levels remain elevated, there is calcium deposition in the wall of blood vessels (
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The patient is placed in a semi-Fowler position and the neck is extended. An abbreviated Kocher incision is made and the platysma muscle is dissected horizontally. The strap muscles are released off of the thyroid gland. Then the thyroid gland is mobilized and the parathyroid arterial blood supply is
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The main indication for parathyroidectomy is primary hyperparathyroidism, a condition in which one or more of the parathyroid glands produce excessive parathyroid hormone. Not all cases of primary hyperparathyroidism require surgery, but it is recommended if the condition causes significant symptoms
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level is back to normal within 10–15 minutes, and can be confirmed by intraoperative rapid assessment during the operation. However, the remaining parathyroid glands may take hours to several weeks to return to their normal functioning levels (as they may have become dormant). Calcium supplements
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in which the parathyroid glands are overactive to compensate for the low calcium and vitamin D levels often present in CKD. In many cases, the parathyroid hormone production improves when these abnormalities are treated with medication. A small proportion, however, have persistently raised hormone
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can help identify the location of glands. It can also be used to limit the extent of surgical exploration when used in conjunction with intraoperative PTH hormone monitoring. The particular problem or disease process will determine how many of the parathyroid glands are removed. Some parathyroid
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Wilhelm, Scott M.; Wang, Tracy S.; Ruan, Daniel T.; Lee, James A.; Asa, Sylvia L.; Duh, Quan-Yang; Doherty, Gerard M.; Herrera, Miguel F.; Pasieka, Janice L.; Perrier, Nancy D.; Silverberg, Shonni J.; Solórzano, Carmen C.; Sturgeon, Cord; Tublin, Mitchell E.; Udelsman, Robert; Carty, Sally E. (1
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suture ligated. The entire parathyroid adenoma is identified and dissected out. Intraoperative PTH monitoring can begin at this time and will show falling PTH levels if the entire adenoma has been resected.
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While mild hypocalcemia is common after partial parathyroidectomy, some people experience persistently prolonged low calcium levels. This is called
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October 2016). "The
American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyperparathyroidism".
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Parathyroidectomy may also be required in secondary hyperparathyroidism. This situation arises mainly in people with severe
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Augustine, MM; Bravo, PE; Zeiger, MA (Mar–Apr 2011). "Surgical treatment of primary hyperparathyroidism".
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may be performed in order to confirm the presence and location of abnormal parathyroid tissue.
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Jain, Nishank; Reilly, Robert F. (July 2017). "Hungry bone syndrome".
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in severe cases) or there is worsening bone disease. In people on
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Surgical removal of one or more of the parathyroid glands
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Recovery after the operation tends to be swift. The
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114:of these glands when they are producing excessive
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443:The American Association of Endocrine Surgeons
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208:tissue must be left in place to help prevent
102:removal of one or more of the (usually) four
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33:Parathyroidectomy for parathyroid adenoma
516:"How is parathyroid surgery performed?"
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106:. This procedure is used to remove an
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191:(unconscious and pain free) or a
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538:. Medline Plus. 3 December 2018
224:and to restore lost bone mass.
771:Dexamethasone suppression test
733:Radioactive iodine uptake test
143:or if it affects the kidneys (
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438:Parathyroid surgery: Recovery
483:10.1097/MNH.0000000000000327
458:https://jomi.com/article/225
827:Surgical removal procedures
670:digestive system procedures
532:"Parathyroid gland removal"
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781:Captopril suppression test
738:Sestamibi parathyroid scan
664:Islet cell transplantation
321:10.1001/jamasurg.2016.2310
285:List of surgeries by type
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695:Transsphenoidal surgery
788:Fluid deprivation test
164:chronic kidney disease
776:ACTH stimulation test
743:TRH stimulation test
536:Medical Encyclopedia
371:10.2215/CJN.10390917
273:hungry bone syndrome
157:spreading elsewhere
120:hyperparathyroidism
116:parathyroid hormone
416:10.4158/EP10359.RA
410:(Suppl 1): 75–82.
404:Endocrine Practice
251:. You can help by
210:hypoparathyroidism
205:sestamibi scanning
189:general anesthetic
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59:Hypoparathyroidism
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149:osteoporosis
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187:requires a
138:Indications
112:hyperplasia
821:Categories
644:procedures
542:8 December
291:References
132:ultrasound
682:Pituitary
668:see also
642:Test and
595:SNOMED CT
260:June 2018
185:operation
179:Procedure
153:malignant
40:Specialty
656:Pancreas
600:53304009
491:28375869
424:21324817
389:29523679
329:27532368
279:See also
173:dialysis
100:surgical
65:Approach
712:Thyroid
589:D016105
499:4630106
380:5989682
337:4007319
118:(PTH):
108:adenoma
98:is the
767:Tests
729:Tests
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197:larynx
130:or an
495:S2CID
333:S2CID
84:[
584:MeSH
578:06.8
573:9-CM
544:2018
524:2019
487:PMID
420:PMID
385:PMID
325:PMID
183:The
68:Open
569:ICD
479:doi
412:doi
375:PMC
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317:doi
313:151
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217:PTH
110:or
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