A 30-year-old male, with end stage kidney disease secondary to diabetic nephropathy on maintenance hemodialysis for seven years. The patient underwent total parathyroidectomy because of tertiary hyperparathyroidism 10 months ago and now presents with bony pains, agitation, and muscle cramps.
Review of his laboratory values are shown in table I
Test
Value
S. Creatinine
4.5 mg/dL
S. corrected Calcium
7.5 mg/dL
Phosphorus
3 mg/dL
PTH
30 pg/mL
Alk-phosphatase/total
90 U/L (30-130)
The patient’s current medications include calcium carbonate 2000 mg and alfacalcidol 0.5 mcg per day.
A) Interpret the above laboratory work-up.
B) What is the likely cause of the patient’s presentation?
C) Evaluate the patient’s current plan of treatment.
D) What is the most frequent complication after parathyroidectomy? How to manage?
30 Comments
Amna Kununa
A) Interpret the above laboratory workup.
low PTH and hypo Ca in the context of parathyroidectomy
B) What is the likely cause of the patient’s presentation?
Hypo Ca
C) Evaluate the patient’s current plan of treatment.
Calcium base phosphate binder and Vit D result in more PTH suppression.
Anabolic agents like Teriparatide; stimulates the number of osteoblasts and osteoclasts, which may result in increased bone turnover
D) What is the most frequent complication after parathyroidectomy? How to manage? 1.Postoperative hypocalcemia
Mild postoperative hypocalcemia may be due to bone hunger or functional hypoparathyroidism resulting from suppression of the remaining normal parathyroid tissue. Responding well to a short course of oral Ca supp.
Severe hypocalcemia — Symptoms include tetany, EKG changes, papilledema, and seizures. Require intravenous and oralcalcium supplementation as well as correction of concomitant hypomagnesemia.
A) Interpret the above laboratory work-up.ESRD with hypoparathyroidism, hypocalcemia and Hypophosphatemia. B) What is the likely cause of the patient’s presentation?Hypocalcemia causing muscle cramps and bony pain.
C) Evaluate the patient’s current plan of treatment.Patient with symptomatic hypocalcemia would require IV calcium infusion and calcitriol to increase Ca and ph levels. Oral Ca is not enough.
D) What is the most frequent complication after parathyroidectomy? How to manage?Hungry Bone syndrome.
Calctriol before surgery and IV Ca gluconate infusion post surgery with frequent monitoring of Ca corr level till reaches Ca corr 2 and patient is asymptomatic
Interpret the above laboratory work-up.CKD patient with hypocalcemia What is the likely cause of the patient’s presentation?hypocalcemia , ABD Evaluate the patient’s current plan of treatment.Calcium and Vitamin D analog close monitoring of ca, Phosphate and PTH and bone markersWhat is the most frequent complication after parathyroidectomy? How to manage?hypocalcemia , hungry bone syndrome, calcification
A -hypocalcaemia due to hypoparathyroid due parathyroidectomy
B-Hypocalcaemia due to above and possibly vitamin D deficiency.
C check vitamin d and replete / can worse ABD tho
D Hypocalcaemia
A; Post parathyroidectomy hypocalcemia
B; Symptomatic hypocalcemia
C;Active vitamin D will cause more suppression of PTH
D; Persistent hypocalcemia , we can give preoperative active vitamin D .
A)case of symptomatic hypocalcemia post parathyroidectomy
B)ABD post parathyroidectomy
C)ca supplement but stop VD
D)bone hungry syndrome post operative and persistent hypocalcemia
treated by maintained on ca supplement till be asymptomatic
A) Interpret the above laboratory work-up.
CKD5-HD- Hypocalcemia- normal PTH and normal ALP.
B) What is the likely cause of the patient’s presentation?
The patient’s presentation is caused by parathyroidectomy leading to hypocalcemia and bone pain seen in this patient.
C) Evaluate the patient’s current plan of treatment.
IV Calcium, Vitamin D analog
Monitor ca, Phosphate and PTH and bone markers
D) What is the most frequent complication after parathyroidectomy? How to manage?
Complications of parathyroidectomy are hypocalcemia- hungry bone syndrome- recurrent laryngeal nerve injury
management: iv calcium, vitamin D supplimentation- correct hypo magnesemia and hypophosphatemia
A) Interpret the above laboratory work-up.Hungry bone syndrome is seen early postoperatively, but this patient has long-staying hypocalcemia along with hypophosphatemia and very suppressed PTH, which is most probably due to dynamic bone disease. B) What is the likely cause of the patient’s presentation?
Adynamic bone disease following parathyroidectomy
Hypocalcemia with hypoparathyroidism
C) Evaluate the patient’s current plan of treatment.This patient will need to Ca supplement without vit D as it will suppress PTH further D) What is the most frequent complication after parathyroidectomy? How to manage?Persistant hypocalcemia
Pre and postoperative intravenous calcium gluconatealong with oral calcium,
Strict follow up serum calcium , magnesium , vitamin D level and PTH.
Hungry bone syndrome is seen early postoperatively, but this patient has long-staying hypocalcemia along with hypophosphatemia and very suppressed PTH, which is most probably due to dynamic bone disease. Replacing calcium and vitamin d (usually oral calcium supplements are a combination of these is needed. Low ALP or biyopy-proven ABD diagnosis can be followed by drugs that facilitate the bone formation, like Teriparatide
Hypocalcemia with hypoparathyroidism What is the likely cause of the patient’s presentation?Hypocalcemia with hypoparathyroidism
Evaluate the patient’s current plan of treatment.stop alphacalcidol as it cause more suppression of pth
add teriparatide
What is the most frequent complication after parathyroidectomy? How to manage?persistant hypocalcemia
avoid total parathyroidectomy preoperative calcitriol and postoperative intravenous calcium gluconatealong with oral calcium, magnesium
strict follow up serum calcium and vitamin d level
Could you interpret the above laboratory workup?This patient has severe hypocalcemia in the setting of severe hypopaRATHYRoidism post-surgery
What is the likely cause of the patient’s presentation?Hypocalcemia and low Vit D level
Evaluate the patient’s current plan of treatment.This patient will need to Ca supplement without vit D as it will suppress PTH further
What is the most frequent complication after parathyroidectomy? How to manage?it advisable to have Calcitriol prior to parathyroidectomy and to give iv Ca gluconate after surgery with close follow up for the ionised Ca level
A) Interpret the above laboratory work-up.
Hypocalcemia and low level of pth and normal level of alkaline phosphatase
B) What is the likely cause of the patient’s presentation? Most likely cause adynamic bone disease following parathyroidectomy and hypocalcemia
C) Evaluate the patient’s current plan of treatment.
We should give patient calcium supplement and avoid active vitamin D supplementation dueto causes more decrease in PTH level that worsens the condition.we trying Teriparatide may help to improve bone formation rate and decrease the risk of fractures.
D) What is the most frequent complication after parathyroidectomy?
Most common complication is persistant hypocalcemia due to low level of pth
How to manage?
Give patient calcium supplement and vit d peri operative and continue post operative
Continues monitoring of serum calcium po4 magnesium vit d level and pth
A) Interpret the above laboratory work-up.
With his history of total parathyroidectomy, he has low level of PTH , hypocalcemia due to extensive parathyroidectomy.
B) What is the likely cause of the patient’s presentation?
Hypocalcemia
Vitamin D deficiency
Low PTH
C) Evaluate the patient’s current plan of treatment.
As he have very low PTH which is responsible for hypocalcemia, so calcium supplementation, avoid active vitamin D as it will cause over suppression of the already suppressed PTH.
Bone anabolic drugs such as teriparatide can improve bone formation.
D) What is the most frequent complication after parathyroidectomy? How to manage?
Persistent hypocalcemia
Treated by giving preoperative calcitriol and postoperative calcium gluconate intravenously with oral calcium.with close follow up.
A. Hypocalcemia due to hypoparathyreoidismus after PTX.
B. Symptomatic hypocalcemia , maybe vitamin D Deficency
C. i will measure vitamin D level, and will correct it or increase calcium intake. Teriparatide is a PTH analogue to treat the hypoparathyroidismus and it will be beneficial in this case.
D. a low calcium level is a frequent complication after parathyreoidectomy . it is managed with giving a large amount of active vitamin D before and after the surgery with calcium if needed . Follow up with vitamin d level , calcium , magnesium and PTH level are needed
The patient has hypoparathyroidism which causes hypocalcimia
B) What is the likely cause of the patient’s presentation?
Due to hypocalcimia and low vitamin D
C) Evaluate the patient’s current plan of treatment.
Calcium supplements and if given vitamin D will cause oversuppresion of pth so can be treated with one of the bone anabolic drug
D) What is the most frequent complication after parathyroidectomy? How to manage?
Hypocalcimia so give calcitriol before surgery and calcium gluconate after surgery with vitamin D and Mg
A- HAS HYPOCALCEMIA , LOW PTH
B- HIS PRESENTATION DUE TO HYPOCALCEMIA
C- CHECK FOR VIT D , GIVE HIME CALCIUM AND VITAMIN D ANALOG MAY NEEDS FOR MORE AGRESIVE TREATMENT
D- HYPOCALCEMIA BONE HUNGER SYNDROME
Model answers by the board: A. Interpret the above laboratory work-up. The patient had a history of total parathyroidectomy, so his PTH level is markedly low. Hypocalcemia is secondary to interactable hypoparathyroidism because of the extensive parathyroidectomy. It is not uncommon to be confronted with this probably severe iatrogenic hypoparathyroidism .
B. What is the likely cause of the patient’s presentation? The cause of the patient presentation may be attributed to either hypocalcemia or vitamin D deficiency. Vitamin D deficiency is common in patients with CKD on HD, so it is recommended to check vitamin D level and give native vitamin D supplementation to replete the vitamin D stores. The very low PTH level that reflects low turnover bone disease is also responsible for the patient’s presentation.
C. Evaluate the patient’s current plan of treatment. The serum PTH level is very low that is responsible for low levels of serum calcium. Active vitamin D supplementation causes more decrease in PTH level that worsens the condition. Teriparatide may help to improve bone formation rate and decrease the risk of fractures. D. What is the most frequent complication after parathyroidectomy? How to manage? The most frequent complication after parathyroidectomy is persistent low serum calcium. It is advised to administer preoperative calcitriol as well as postoperative intravenous calcium gluconate, along with oral calcium, magnesium, and vitamin D (calcitriol) when necessary. Laboratory values obtained over time indicate the adequacy of vitamin D repletion and the degree of long-term cure include: total and ionized serum calcium, serum magnesium and PTH level. 25 (OH ) vitamin D should be measured.
Interpret the above laboratory work-up:
Low Ca, PO4, and low iPTH, normal Alk phosphatase: manifestations of post-parathyroidectomy.
What is the likely cause of the patient’s presentation?
Late post-parathyroidectomy complication. These symptoms may be explained by a condition called parathyroidectomy, which has an outcome as a consequence of its presence: symptomatic Hypocalcemia
Evaluate the patient’s current plan of treatment.
The patient presented with severe symptoms of hypocalcemia. He needs IV calcium to control the symptoms and increase the dose of vitamin D to 2ug once per day and titrate according to the symptoms. What is the most frequent complication after parathyroidectomy?
Hungry bone syndrome, laryngeal nerve injury, adynamic bone disease, Hypocalcemia,, Hypophosphatemia,Hypomagnesemia
How to manage?
oral calcium supplementation (2–4 g elemental calcium [50–100 mmol] per day) should begin.
Calcium should be taken between meals if serum phosphorus is normal or low.
If the patient develops frank or latent tetany or a fast and gradual decrease in blood calcium, intravenous calcium is recommended.
Vitamin D supplementation helps maintain dialysis users, who are typically vitamin D deficient if they haven’t been taking it. In a placebo-controlled experiment, postoperative oral calcitriol up to 4 mcg/day reduced the blood calcium drop.
A) Interpret the above laboratory work-up.Labs reveal hypocalcemia, hypophosphatemia, and low iPTH, these are indicative of ABD, tALP is normal (Expected) B) What is the likely cause of the patient’s presentation?These symptoms are typical symptoms of Hypocalcemia C) Evaluate the patient’s current plan of treatment.Needs admission to high dependency unit, IV Ca, Increase his Oral Ca, and needs high doses of Active VitaminD, Teriparatide can be considered. D) What is the most frequent complication after parathyroidectomy? How to manage?Hypoparathyroidism, manifesting as hypocalcemia.Treated with oral Ca supplementation, VitD (Active), and ? Teriparatide
A) Interpret the above laboratory work-up.
Low Ca, PO4, and low iPTH, normal Alk phosphatase
manifestations of post-parathyroidectomy.
B) What is the likely cause of the patient’s presentation?Late post-parathyroidectomy complication. These symptoms may be explained by a condition called parathyroidectomy, which has an outcome as a consequence of its presence: symptomatic Hypocalcemia
C) Evaluate the patient’s current plan of treatment.The patient presented with severe symptoms of hypocalcemia. He needs IV calcium to control the symptoms and increase the dose of vitamin D to 2ug once per day and titrate according to the symptoms. D) What is the most frequent complication after parathyroidectomy? How to manage?Hungry bone syndrome
laryngeal nerve injury
adynamic bone disease Hypocalcemia, Hypophosphatemia,Hypomagnesemia
As soon as the patient can swallow, oral calcium supplementation (2–4 g elemental calcium [50–100 mmol] per day) should begin. Calcium should be taken between meals if serum phosphorus is normal or low.
If the patient develops frank or latent tetany or a fast and gradual decrease in blood calcium, intravenous calcium is recommended.
Vitamin D supplementation helps maintain dialysis users, who are typically vitamin D deficient if they haven’t been taking it. In a placebo-controlled experiment, postoperative oral calcitriol up to 4 mcg/day reduced the blood calcium drop.
Severe hypocalcemia most likely due to total parathyroidectomy
Normal PO4
iPTH at the lower end of normal, may be very low for him versus his baseline prior to surgery
Normal tALP
B) What is the likely cause of the patient’s presentation?-These symptoms can be explained by parathyroidecomy which has resulted into two things:
Severe hypocalemia
Adynamic bone disease (ABD)
C) Evaluate the patient’s current plan of treatment.-The current managment is not bad but it has to be modified a bit in the view of symptomatic hypocalcemia:
Admit to HDU
IV 10% calcium gluconate infusion 50 ml X 500 ml D5% at rate of 50 ml/h
Recheck Ca after one hour and adjust accordingly
Continuous cardiac monitotring
Alfacalcidol may be increase up to 2 mcg/day
Calcium may be increase to 3 g/day as oupatient
-D) What is the most frequent complication after parathyroidectomy? How to manage?A.Hypocalemia
Monitor Ca 2-4hr post-op, then every 12 hours for 2 to 3 days
Consider giving calcitriol 1-3 g/day puls alfacalcidol in the range of 0.5 to 2 mcg/day
B.PTH
Measure PTH intra & postoperatively to confirm success
The lab revealed :-
Hypocalcemia
Hypophosphatemia
PTH normal not activate
normal alkaline phosphatase
The pt. presented with manifestation of hypocalcemia as agitation , bony ach ,
muscle cramps , tetany ., or seizure
the current plan treatment is ok but the calcium carbonate should be taken 2-3h after meal as calcium supplement
not with meal as phosphate binder
and should be follow up and close monitoring ca . pi , pth , vit D
the most frequent complication after parathyroidectomy1- hungry bone syndrome >>>. prolonged and sever hypocalcemia
the pt. presented with numbness , tingling sensation in the finger and toes , muscle cramps , tetany , and seizures
2- long term result of parathyroidectomy . HYPERCALCEMIC crisis
A- renal impairment with hypocalcemia , normal po4 levels , suppressed PTH and normal ALP
B- low turnover bone disease secondary to parathyroidectomy (hungry bone syndrome)
C- calcium therapy and calcitriol should be stopped
D- hungry bone syndrome…anabolic agents as teriparatide and monoclonal ABs
A) Interpret the above laboratory workup.
low PTH and hypo Ca in the context of parathyroidectomy
B) What is the likely cause of the patient’s presentation?
Hypo Ca
C) Evaluate the patient’s current plan of treatment.
D) What is the most frequent complication after parathyroidectomy? How to manage? 1.Postoperative hypocalcemia
2.Permanent hypoparathyroidism
A) Interpret the above laboratory work-up.ESRD with hypoparathyroidism, hypocalcemia and Hypophosphatemia.
B) What is the likely cause of the patient’s presentation?Hypocalcemia causing muscle cramps and bony pain.
C) Evaluate the patient’s current plan of treatment.Patient with symptomatic hypocalcemia would require IV calcium infusion and calcitriol to increase Ca and ph levels. Oral Ca is not enough.
D) What is the most frequent complication after parathyroidectomy? How to manage?Hungry Bone syndrome.
Calctriol before surgery and IV Ca gluconate infusion post surgery with frequent monitoring of Ca corr level till reaches Ca corr 2 and patient is asymptomatic
Interpret the above laboratory work-up.CKD patient with hypocalcemia
What is the likely cause of the patient’s presentation?hypocalcemia , ABD
Evaluate the patient’s current plan of treatment.Calcium and Vitamin D analog
close monitoring of ca, Phosphate and PTH and bone markersWhat is the most frequent complication after parathyroidectomy? How to manage?hypocalcemia , hungry bone syndrome, calcification
A -hypo ca
B-Hypocalcaemia +vitamin D deficiency.
C check vitamin d and stop one alpha
D Hypocalcaemia
A -hypocalcaemia due to hypoparathyroid due parathyroidectomy
B-Hypocalcaemia due to above and possibly vitamin D deficiency.
C check vitamin d and replete / can worse ABD tho
D Hypocalcaemia
A; Post parathyroidectomy hypocalcemia
B; Symptomatic hypocalcemia
C;Active vitamin D will cause more suppression of PTH
D; Persistent hypocalcemia , we can give preoperative active vitamin D .
A)case of symptomatic hypocalcemia post parathyroidectomy
B)ABD post parathyroidectomy
C)ca supplement but stop VD
D)bone hungry syndrome post operative and persistent hypocalcemia
treated by maintained on ca supplement till be asymptomatic
A)
Symptomatic hypocalcemia, with possible ABD, due to overtreatment.
B)
ABD.
C)
E)
A) Interpret the above laboratory work-up.
CKD5-HD- Hypocalcemia- normal PTH and normal ALP.
B) What is the likely cause of the patient’s presentation?
The patient’s presentation is caused by parathyroidectomy leading to hypocalcemia and bone pain seen in this patient.
C) Evaluate the patient’s current plan of treatment.
IV Calcium, Vitamin D analog
Monitor ca, Phosphate and PTH and bone markers
D) What is the most frequent complication after parathyroidectomy? How to manage?
Complications of parathyroidectomy are hypocalcemia- hungry bone syndrome- recurrent laryngeal nerve injury
management: iv calcium, vitamin D supplimentation- correct hypo magnesemia and hypophosphatemia
A) Interpret the above laboratory work-up.Hungry bone syndrome is seen early postoperatively, but this patient has long-staying hypocalcemia along with hypophosphatemia and very suppressed PTH, which is most probably due to dynamic bone disease.
B) What is the likely cause of the patient’s presentation?
C) Evaluate the patient’s current plan of treatment.This patient will need to Ca supplement without vit D as it will suppress PTH further
D) What is the most frequent complication after parathyroidectomy? How to manage?Persistant hypocalcemia
Hungry bone syndrome is seen early postoperatively, but this patient has long-staying hypocalcemia along with hypophosphatemia and very suppressed PTH, which is most probably due to dynamic bone disease. Replacing calcium and vitamin d (usually oral calcium supplements are a combination of these is needed. Low ALP or biyopy-proven ABD diagnosis can be followed by drugs that facilitate the bone formation, like Teriparatide
Hypocalcemia with hypoparathyroidism
What is the likely cause of the patient’s presentation?Hypocalcemia with hypoparathyroidism
Evaluate the patient’s current plan of treatment.stop alphacalcidol as it cause more suppression of pth
add teriparatide
What is the most frequent complication after parathyroidectomy? How to manage?persistant hypocalcemia
avoid total parathyroidectomy
preoperative calcitriol and postoperative intravenous calcium gluconatealong with oral calcium, magnesium
strict follow up serum calcium and vitamin d level
Could you interpret the above laboratory workup?This patient has severe hypocalcemia in the setting of severe hypopaRATHYRoidism post-surgery
What is the likely cause of the patient’s presentation?Hypocalcemia and low Vit D level
Evaluate the patient’s current plan of treatment.This patient will need to Ca supplement without vit D as it will suppress PTH further
What is the most frequent complication after parathyroidectomy? How to manage?it advisable to have Calcitriol prior to parathyroidectomy and to give iv Ca gluconate after surgery with close follow up for the ionised Ca level
A) Interpret the above laboratory work-up.
Hypocalcemia and low level of pth and normal level of alkaline phosphatase
B) What is the likely cause of the patient’s presentation? Most likely cause adynamic bone disease following parathyroidectomy and hypocalcemia
C) Evaluate the patient’s current plan of treatment.
We should give patient calcium supplement and avoid active vitamin D supplementation dueto causes more decrease in PTH level that worsens the condition.we trying Teriparatide may help to improve bone formation rate and decrease the risk of fractures.
D) What is the most frequent complication after parathyroidectomy?
Most common complication is persistant hypocalcemia due to low level of pth
How to manage?
Give patient calcium supplement and vit d peri operative and continue post operative
Continues monitoring of serum calcium po4 magnesium vit d level and pth
A) Interpret the above laboratory work-up.
With his history of total parathyroidectomy, he has low level of PTH , hypocalcemia due to extensive parathyroidectomy.
B) What is the likely cause of the patient’s presentation?
Hypocalcemia
Vitamin D deficiency
Low PTH
C) Evaluate the patient’s current plan of treatment.
As he have very low PTH which is responsible for hypocalcemia, so calcium supplementation, avoid active vitamin D as it will cause over suppression of the already suppressed PTH.
Bone anabolic drugs such as teriparatide can improve bone formation.
D) What is the most frequent complication after parathyroidectomy? How to manage?
Persistent hypocalcemia
Treated by giving preoperative calcitriol and postoperative calcium gluconate intravenously with oral calcium.with close follow up.
A. Hypocalcemia due to hypoparathyreoidismus after PTX.
B. Symptomatic hypocalcemia , maybe vitamin D Deficency
C. i will measure vitamin D level, and will correct it or increase calcium intake. Teriparatide is a PTH analogue to treat the hypoparathyroidismus and it will be beneficial in this case.
D. a low calcium level is a frequent complication after parathyreoidectomy . it is managed with giving a large amount of active vitamin D before and after the surgery with calcium if needed . Follow up with vitamin d level , calcium , magnesium and PTH level are needed
A) Interpret the above laboratory work-up.
The patient has hypoparathyroidism which causes hypocalcimia
B) What is the likely cause of the patient’s presentation?
Due to hypocalcimia and low vitamin D
C) Evaluate the patient’s current plan of treatment.
Calcium supplements and if given vitamin D will cause oversuppresion of pth so can be treated with one of the bone anabolic drug
D) What is the most frequent complication after parathyroidectomy? How to manage?
Hypocalcimia so give calcitriol before surgery and calcium gluconate after surgery with vitamin D and Mg
A- HAS HYPOCALCEMIA , LOW PTH
B- HIS PRESENTATION DUE TO HYPOCALCEMIA
C- CHECK FOR VIT D , GIVE HIME CALCIUM AND VITAMIN D ANALOG MAY NEEDS FOR MORE AGRESIVE TREATMENT
D- HYPOCALCEMIA BONE HUNGER SYNDROME
A) Interpret the above laboratory work-up.CKD 5D
hypocalcemia .low PTH below target
B) What is the likely cause of the patient’s presentation?due to low calcium and vitamin D
C) Evaluate the patient’s current plan of treatment.check vitamin D level and correct if low
serum magnesium
Model answers by the board:
A. Interpret the above laboratory work-up.
The patient had a history of total parathyroidectomy, so his PTH level is markedly low. Hypocalcemia is secondary to interactable hypoparathyroidism because of the extensive parathyroidectomy. It is not uncommon to be confronted with this probably severe iatrogenic hypoparathyroidism .
B. What is the likely cause of the patient’s presentation?
The cause of the patient presentation may be attributed to either hypocalcemia or vitamin D deficiency. Vitamin D deficiency is common in patients with CKD on HD, so it is recommended to check vitamin D level and give native vitamin D supplementation to replete the vitamin D stores.
The very low PTH level that reflects low turnover bone disease is also responsible for the patient’s presentation.
C. Evaluate the patient’s current plan of treatment.
The serum PTH level is very low that is responsible for low levels of serum calcium. Active vitamin D supplementation causes more decrease in PTH level that worsens the condition. Teriparatide may help to improve bone formation rate and decrease the risk of fractures.
D. What is the most frequent complication after parathyroidectomy? How to manage?
The most frequent complication after parathyroidectomy is persistent low serum calcium. It is advised to administer preoperative calcitriol as well as postoperative intravenous calcium gluconate, along with oral calcium, magnesium, and vitamin D (calcitriol) when necessary. Laboratory values obtained over time indicate the adequacy of vitamin D repletion and the degree of long-term cure include: total and ionized serum calcium, serum magnesium and PTH level. 25 (OH ) vitamin D should be measured.
Interpret the above laboratory work-up:
Low Ca, PO4, and low iPTH, normal Alk phosphatase: manifestations of post-parathyroidectomy.
What is the likely cause of the patient’s presentation?
Late post-parathyroidectomy complication. These symptoms may be explained by a condition called parathyroidectomy, which has an outcome as a consequence of its presence: symptomatic Hypocalcemia
Evaluate the patient’s current plan of treatment.
The patient presented with severe symptoms of hypocalcemia. He needs IV calcium to control the symptoms and increase the dose of vitamin D to 2ug once per day and titrate according to the symptoms.
What is the most frequent complication after parathyroidectomy?
How to manage?
Calcium should be taken between meals if serum phosphorus is normal or low.
Interpret the above laboratory work-up.
What is the likely cause of the patient’s presentation?
Evaluate the patient’s current plan of treatment.
What is the most frequent complication after parathyroidectomy? How to manage?
A) Interpret the above laboratory work-up.Labs reveal hypocalcemia, hypophosphatemia, and low iPTH, these are indicative of ABD, tALP is normal (Expected)
B) What is the likely cause of the patient’s presentation?These symptoms are typical symptoms of Hypocalcemia
C) Evaluate the patient’s current plan of treatment.Needs admission to high dependency unit, IV Ca, Increase his Oral Ca, and needs high doses of Active VitaminD, Teriparatide can be considered.
D) What is the most frequent complication after parathyroidectomy? How to manage?Hypoparathyroidism, manifesting as hypocalcemia.Treated with oral Ca supplementation, VitD (Active), and ? Teriparatide
A) Interpret the above laboratory work-up.
Low Ca, PO4, and low iPTH, normal Alk phosphatase
post-parathyroidectomy.
B) What is the likely cause of the patient’s presentation?Late Hypocalcemia due to parathyroidectomy.
hungry bone .
C) Evaluate the patient’s current plan of treatment.
The patient presented with severe symptoms of hypocalcemia.
admission in MICU
D) What is the most frequent complication after parathyroidectomy? How to manage?
A) Interpret the above laboratory work-up.
Low Ca, PO4, and low iPTH, normal Alk phosphatase
manifestations of post-parathyroidectomy.
B) What is the likely cause of the patient’s presentation?Late post-parathyroidectomy complication. These symptoms may be explained by a condition called parathyroidectomy, which has an outcome as a consequence of its presence: symptomatic Hypocalcemia
C) Evaluate the patient’s current plan of treatment.The patient presented with severe symptoms of hypocalcemia. He needs IV calcium to control the symptoms and increase the dose of vitamin D to 2ug once per day and titrate according to the symptoms.
D) What is the most frequent complication after parathyroidectomy? How to manage?Hungry bone syndrome
laryngeal nerve injury
adynamic bone disease
Hypocalcemia, Hypophosphatemia,Hypomagnesemia
As soon as the patient can swallow, oral calcium supplementation (2–4 g elemental calcium [50–100 mmol] per day) should begin. Calcium should be taken between meals if serum phosphorus is normal or low.
If the patient develops frank or latent tetany or a fast and gradual decrease in blood calcium, intravenous calcium is recommended.
Vitamin D supplementation helps maintain dialysis users, who are typically vitamin D deficient if they haven’t been taking it. In a placebo-controlled experiment, postoperative oral calcitriol up to 4 mcg/day reduced the blood calcium drop.
A) Interpret the above laboratory work-up.
B) What is the likely cause of the patient’s presentation?-These symptoms can be explained by parathyroidecomy which has resulted into two things:
C) Evaluate the patient’s current plan of treatment.-The current managment is not bad but it has to be modified a bit in the view of symptomatic hypocalcemia:
-D) What is the most frequent complication after parathyroidectomy? How to manage?A.Hypocalemia
B.PTH
C.Haemorrhage (rare complication)
Summary : parathyroidectomy may results in
*Patient will required close intra & postop monitoring with adequate Ca & VDRA supplementation
The lab revealed :-
Hypocalcemia
Hypophosphatemia
PTH normal not activate
normal alkaline phosphatase
The pt. presented with manifestation of hypocalcemia as agitation , bony ach ,
muscle cramps , tetany ., or seizure
the current plan treatment is ok but the calcium carbonate should be taken 2-3h after meal as calcium supplement
not with meal as phosphate binder
and should be follow up and close monitoring ca . pi , pth , vit D
the most frequent complication after parathyroidectomy1- hungry bone syndrome >>>. prolonged and sever hypocalcemia
the pt. presented with numbness , tingling sensation in the finger and toes , muscle cramps , tetany , and seizures
2- long term result of parathyroidectomy . HYPERCALCEMIC crisis
A- renal impairment with hypocalcemia , normal po4 levels , suppressed PTH and normal ALP
B- low turnover bone disease secondary to parathyroidectomy (hungry bone syndrome)
C- calcium therapy and calcitriol should be stopped
D- hungry bone syndrome…anabolic agents as teriparatide and monoclonal ABs
A) Interpret the above laboratory work-up.
B) What is the likely cause of the patient’s presentation?
C) Evaluate the patient’s current plan of treatment.
D) What is the most frequent complication after parathyroidectomy? How to manage?