Surgery of the parathyroids
1. Big picture
Parathyroid surgery is mainly surgery for hyperparathyroidism, especially primary hyperparathyroidism caused by a parathyroid adenoma. The examiner wants you to understand the full logic:
High calcium
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Measure parathyroid hormone — PTH
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PTH high or inappropriately normal?
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Primary / secondary / tertiary hyperparathyroidism
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Decide if surgery is indicated
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Localize abnormal gland if primary disease
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Perform focused or bilateral neck exploration
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Confirm cure by intraoperative PTH fall
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Monitor postoperative calcium
The key surgical danger after parathyroidectomy is hypocalcemia, especially hungry bone syndrome in severe bone disease or renal hyperparathyroidism.
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