What Can I Expect During Hyperparathyroidism Surgery?

Hyperparathyroidism is the excessive secretion of parathyroid hormone (PTH) from the nail nails. Bone pain, fractures and urinary tract stones are common disorders that bother people's lives, and one of the important causes of the above diseases is hyperparathyroidism. Misdiagnosis and mistreatment are common due to insufficient understanding of hyperparathyroidism, which not only wastes the patient's energy and financial resources, seriously affects the patient's quality of life, but also leads to irreversible organ damage and even death.

Wei Bojun

(Chief physician)

Department of Otolaryngology Head and Neck Surgery, Beijing Shijitan Hospital, Capital Medical University

Hyperparathyroidism is the excessive secretion of parathyroid hormone (PTH) from the nail nails. The parathyroid glands have undergone pathological changes, such as hyperplasia, neoplasia, or even canceration. Due to other physical conditions in the body, such as chronic vitamin D deficiency, hyperparathyroidism may result. Hyperparathyroidism can cause bone pain, fractures, hypercalcemia, etc. It can also harm many other systems of the body and requires active diagnosis and treatment.

Western Medicine Name: Hyperparathyroidism
English name: hyperparathyroidism
Affiliated Department: surgical-
Disease site: Parathyroid glands

The main symptoms: Unexplained body soreness, indifferent or irritable, unexplained constipation
Main cause: Hyperparathyroidism, neoplasia, canceration, chronic vitamin D deficiency, small bowel dysfunction, renal insufficiency, etc.

Introduction to Hyperparathyroidism

Causes of Hyperparathyroidism

The most important function of parathyroid glands is to maintain the relative stability of human calcium levels by increasing or decreasing the secretion of parathyroid hormone. The causes of hyperparathyroidism can be divided into three types:

1 The parathyroid gland itself has pathological changes, such as hyperproliferation, neoplasia, or even canceration, which is medically called primary hyperparathyroidism;

2 Due to other conditions in the body, such as chronic vitamin D deficiency, small intestinal dysfunction or renal insufficiency, blood calcium is lower than normal, and parathyroid hormone is required to increase the secretion of parathyroid hormone to increase blood calcium levels. It is considered to be compensatory hyperthyroidism and is called secondary hyperparathyroidism;

3 On the basis of long-term secondary hyperthyroidism, tumorous changes have occurred in the parathyroid glands, which is called triple hyperparathyroidism. In another case, the parathyroid gland itself does not have the above-mentioned lesions, but because other diseased organs in the body secrete substances similar to parathyroid hormone, its performance is largely the same as excessive secretion of parathyroid hormone, which is medically called It is pseudohypoparathyroidism, not really hyperparathyroidism. ^[1]

Harm of Hyperparathyroidism Disease

Bone pain: When hyperparathyroidism increases, bone resorption increases, causing osteoporosis to occur earlier, faster, and more severely. Basically, there are different degrees of bone pain symptoms, especially more pronounced in the waist and legs. Tired, heavy people have difficulty walking and can't even stand. X-ray examination or CT examination often shows obvious osteoporosis, and even obvious bone damage, similar to bone tumors, and some patients even mistakenly undergo surgery for this.

Fractures: Long-term hyperparathyroidism not only exacerbates osteoporosis, but also causes fibrous osteitis. Such patients often have significant shortness of body and deformities of the limbs. Patients with this disease can do it during light exercise or collision. A fracture, a pathological fracture in medical terms, is at risk of paralysis if it occurs in the vertebra.

Hypercalcemia-related damage: Under normal circumstances, the amount of calcium absorbed by the body from the outside world is basically equal to the amount of calcium excluded from the body, but in the case of primary hyperparathyroidism, due to the continuous excessive release of bone calcium, from The intestinal absorption also increases, and the amount of calcium that enters the blood is much greater than the amount of calcium that is excluded from the body. Therefore, the blood calcium concentration is higher than normal, which is called hypercalcemia. A similar situation occurs in triple or pseudohyperparathyroidism.

Due to the presence of hypercalcemia, coupled with the release of bone matrix and changes in urine pH, it is easy to cause repeated urinary calculi. The continuous deposition of calcium salts in the renal parenchyma also gradually reduces renal function, even renal failure and uremia. .

Hypercalcemia can also harm many other systems of the body, such as the cardiac circulatory system, neuromuscular motor system, digestive system, and central nervous system. It can be manifested as cardiac arrhythmia, fatigue, fatigue, abdominal distension, poor appetite, constipation, abdominal pain, and mental and emotional abnormalities. In general, the performance of the above systems is positively correlated with blood calcium levels, but also related to individual sensitivity, length of medical history, and the rate of rise of blood calcium. The dangers of hypercalcemia have systemic characteristics, which can lead to abnormal blood glucose, lipid metabolism, and disturbance of blood pressure regulation. Long-term hypercalcemia can also cause the deposition of calcium salts in joints, tendons, brain tissue and cornea, causing calcification of ectopic soft tissues. It is worth pointing out that even benign parathyroid tumors can be life-threatening, the main reason being hypercalcemia.

Clinical manifestations of hyperparathyroidism

Symptoms of hyperparathyroidism disease

Detection of blood parathyroid hormone is a necessary means to diagnose hyperparathyroidism. People with the following manifestations should actively perform this test.

1Unexplained general soreness, fatigue, or joint pain

2 repeated urinary stones hair author

3 Unexplained mental activity abnormalities, such as indifferent feelings or irritability, especially with drinking and urine

4Unexplained constipation, anorexia, abdominal distension, abdominal pain, or repeated peptic ulcers or pancreatitis, etc.

5 long-term renal dysfunction,

6 people with elevated calcium

7 Bone mineral density is significantly higher than that of people of the same sex and age

8Patients with a history of tumors such as thyroid, adrenal or pituitary gland

Diagnosis of Hyperparathyroidism

Assistant examination of hyperparathyroidism

1. Neck B-mode ultrasound examination, which has a space-occupying change in common parts of the parathyroid gland, is non-invasive, economical, and easy to repeat. It is currently the preferred imaging method.

2. CT or MRI of the neck: It is of great significance to find heterotopic parathyroid glands in the mediastinum.

3. 99mTcMIBI parathyroid imaging: a highly sensitive examination method, especially for the detection of multiple, ectopic or metastatic lesions

However, each of the above tests has the possibility of false positives and false negatives. Its accuracy is affected not only by the examiner's experience, but also by the location of the parathyroid glands, the pathological characteristics of the parathyroid glands, and the presence or absence of secondary changes such as necrosis.

In addition to the commonly used methods mentioned above, there are still venous segmental blood collection and highly selective angiography, but due to its invasiveness and high cost, it is generally not used as a first-line inspection method. ^[2]

Diagnosis of hyperparathyroidism

In addition to determining the type of hyperparathyroidism, in addition to elevated parathyroid hormone levels, a comprehensive analysis is required in conjunction with the medical history and other test results.

Primary hyperparathyroidism with high blood calcium, low blood phosphorus, high urine calcium, and high urine phosphorus

Hypocalcemia, hypocalcemia, and hyperphosphatemia are secondary hyperparathyroidism. If hypercalcemia occurs on this basis, it is triple hyperparathyroidism.

High blood calcium and low parathyroid hormone in the whole segment, you must be highly vigilant of pseudohyperparathyroidism caused by tumors, and a systemic examination must be performed to determine the source of the tumor.

It should be pointed out that the above classification methods are not absolute or static. For example, renal insufficiency can be the result of primary hyperparathyroidism, or the cause of secondary hyperparathyroidism, which needs comprehensive analysis and judgment.

Treatment of Hyperparathyroidism

The treatment of hyperparathyroidism is closely related to its cause and extent, and should be treated differently.

Treatment of primary hyperparathyroidism

First of all, patients with primary hyperparathyroidism should be actively treated, because the harm of this type of hyperparathyroidism generally has long-term and progressive characteristics. The longer the harm, the greater the harm. It can even lead to coma and cardiac arrest which can be life threatening. In fact, the most common cause of death in primary hyperparathyroidism is uncontrollable hypercalcemia. Although this type of hyperparathyroidism can be temporarily relieved by drug treatment, its effect will gradually weaken or even be ineffective. Surgical resection is currently the only cure.

Treatment of secondary hyperparathyroidism with hyperparathyroidism

If the cause of secondary parathyroid function can be eliminated, hyperparathyroidism is mostly regressable, and parathyroid glands need not be removed. As for whether secondary hyperparathyroidism due to long-term renal insufficiency requires surgery depends mainly on the degree of hyperparathyroidism. Generally speaking, if one of the following conditions is met, surgical treatment should be considered: (1) hypercalcemia, (2) severe bone dystrophy, (3) bone pain or itching of the skin, and (4) persistently increased alkaline phosphatase. Once the secondary hyperparathyroidism has evolved into the triple hyperparathyroidism, surgical treatment is inevitable.

What are the main risks of parathyroid surgery? How to reduce the risk of surgery?

When it comes to surgery, people often develop fear and worry about complications from surgery. Admittedly, like any surgery, parathyroid surgery also has potential risks, and the degree of risk depends mainly on the pathological nature of the parathyroid glands, the specific location, the patient's physical condition, and the skill level of the surgeon. But no matter what type of parathyroid surgery, the greatest risk is larynx function damage. This is mainly because the parathyroid glands are very closely related to laryngeal cartilage, laryngeal muscles, and laryngeal nerves. In particular, the laryngeal nerve is very small. In many cases, the parathyroid gland is directly attached to the laryngeal nerve. Parathyroid cancer can even be directly entangled with the laryngeal or laryngeal nerve. It is easy to damage the laryngeal function during surgery and cause hoarseness. Even breathing is difficult, leaving a lifetime inconvenience. Therefore, only doctors who are very familiar with the various structures of the larynx can correctly deal with complex and changeable conditions during surgery, which can achieve the purpose of treating diseases and avoid damaging the function of the larynx. Fortunately, this risk has been significantly reduced with the rise of surgeons, especially with the rapid rise of ENT surgery.

The incidence of primary hyperparathyroidism increases with age, so it is more common in the elderly. Many elderly patients and their families are worried about the intolerance of surgery. In fact, this kind of worry is generally unnecessary, mainly because conditional hospitals can basically use minimally invasive methods to remove the diseased parathyroid glands, and only a small incision (usually 3 cm) can be used. Complete the operation safely, the operation time is about 40 minutes, and the amount of bleeding during the operation is minimal (usually less than 10 ml). On the day of surgery, normal speaking, eating, and going to the ground can be performed. However, if it is a parathyroid carcinoma, the laryngeal body, larynx nerve and lymph nodes often need to be treated, and tracheotomy is sometimes required, and the operation time will be prolonged accordingly. Fortunately, the incidence of parathyroid carcinoma is very low, accounting for only about 5% of patients with primary hyperparathyroidism. It is worth pointing out that the first surgical treatment of parathyroid cancer is particularly important. Once the first surgery fails, not only will the difficulty of reoperation increase, the risk will increase, but the main effect is that the efficacy will be significantly reduced, and even the opportunity to cure is lost. A large number of examples have been confirmed at home and abroad. ^[3]

Nursing of hyperparathyroidism disease

After the operation is not the end of the entire treatment. If the preoperative hyperparathyroidism is very serious or combined with severe bone damage, it is easy to cause staged hypocalcemia after surgery, limb numbness, convulsions, and respiratory spasms, which are also life-threatening , Should be gradually restored under the guidance of a doctor.

Patients with other conditions such as severe renal dysfunction must still be treated accordingly

It is necessary to add calcium appropriately and arrange appropriate amount of exercise according to the situation.

Prognosis of hyperparathyroidism disease

The prognosis of hyperparathyroidism is related to its intrinsic factors such as etiology, degree, and comorbidities, and it is also related to whether the treatment method is scientific. Most primary hyperparathyroidism can be cured. The earlier the treatment, the more complete the recovery. Myasthenia and psychiatric symptoms can often disappear after successful surgery, and osteoporosis can be improved, but renal damage or fibrocystic osteitis that has already occurred is difficult to recover. It is worth pointing out that whether the first surgery for parathyroid carcinoma is scientific and standardized is the most important influencing factor in determining whether to get a cure. However, the challenge for doctors is that it is often impossible to effectively distinguish between parathyroid adenoma and parathyroid cancer before surgery, and it is necessary to further judge the benign and malignant tumors based on what they have seen during the operation.

Expert opinion on hyperparathyroidism

In short, positive certainty, accurate positioning, and scientific surgery are necessary prerequisites for high-quality treatment of hyperparathyroidism, as well as necessary conditions for ensuring the safety of surgery. Due to the large number of parathyroid glands, there is a certain recurrence rate, but recurrence caused by hyperplasia or adenoma can still be cured. Even recurrent parathyroid cancer still has hope for cure, so the treatment of this disease should be full of confidence .