Two-Year Follow-Up of Parathyroid Hormone, Calcium, and Vitamin D Serum Levels in a Patient after Parathyroidectomy

Authors

  • Alexander Kam Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty, Universitas Andalas, Padang, Indonesia/Dr. M. Djamil General Hospital, Padang, Indonesia Author
  • Dinda Aprilia Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty, Universitas Andalas, Padang, Indonesia/Dr. M. Djamil General Hospital Author
  • Eva Decroli Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty, Universitas Andalas, Padang, Indonesia/Dr. M. Djamil General Hospital Author
  • Syafril Syahbuddin Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty, Universitas Andalas, Padang, Indonesia/Dr. M. Djamil General Hospital Author

DOI:

https://doi.org/10.66266/inajemd.v2i1.37

Keywords:

Parathyroidectomy, parathyroid hormone, calcium, vitamin D

Abstract

Parathyroidectomy is the definitive treatment for primary hyperparathyroidism. Because of the hungry bone syndrome and prolonged hypocalcemia risk, we must follow up on a patient's parathyroid hormone, calcium, and vitamin D serum after parathyroidectomy. In this case report, we reported on a parathyroidectomy patient whom we followed for two years and who, interestingly, had elevated parathyroid hormone levels. A 35-year-old male patient diagnosed with a left parathyroid tumor underwent parathyroidectomy and isthmolobectomy. The patient was treated with calcium, vitamin D, and levothyroxine supplementation. We diagnosed the patient with hungry bone syndrome on the fourth day of post-parathyroidectomy. Then, we documented calcium, vitamin D, and PTH levels in the next two years. The calcium levels are 7.2 (June 2022), 8.2 (July 2022), 8.5 (September 2022), 7.8 (October 2022), 8.1 (June 2023), 9.7 (June 2024). The PTH levels are 244.2 (June 2022), 328.3 (July 2022), 306.5 (September 2022), 457.2 (October 2022), 163.3 (June 2023), 34.4 (June 2024). The Vitamin D levels are 34.4 (July 2022), 13.4 (March 2023), 35.2 (September 2023), 50.4 (April 2024). We increased the dose of calcium and vitamin D supplementation. The patient is in good condition and has reached a normal level of these laboratory parameters in the second year post-parathyroidectomy. PTH, calcium, and vitamin D serum are needed for follow-up in patients after parathyroidectomy. Normalizing calcium and vitamin D serum is essential to maintaining a normal PTH level. Normal PTH, calcium, and vitamin D serum are the cure indications in this patient.

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Author Biography

  • Alexander Kam, Metabolic Endocrinology and Diabetes Division, Internal Medicine Department, Medical Faculty, Universitas Andalas, Padang, Indonesia/Dr. M. Djamil General Hospital, Padang, Indonesia

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References

1. Wilhelm SM, Wang TS, Ruan DT, et al. The American Association of Endocrine Surgeons Guidelines for Definitive Management of Primary Hyper-

parathyroidism. JAMA Surg. 2016;151(10):959-68.

2. Pasieka JL, Parsons L, Jones J. The long-term benefit of parathyroidectomy in primary hyperparathyroidism: a 10-year prospective surgical outcome study. Surgery. 2009;146(6): 1006-13.

3. Ambrogini E, Cetani F, Cianferotti L, et al. Surgery or surveillance for mild asymptomatic primary hyperparathyroidism: a prospective, randomized clinical trial.J Clin Endocrinol Metab. 2007;92(8):3114-21.

4. Stack BC Jr, Bimston DN, Bodenner DL, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Disease state clinical review: postoperative hypoparathyroidism— definitions and management. Endocr Pract. 2015;21(6):674-85.

5. Jain N, Reilly RF. Hungry bone syndrome. Curr Opin Nephrol Hypertens. 2017 Jul;26(4):250-5

6. Karunakaran P, Maharajan C, Ramalingam S, Rachmadugu SV. Is hungry bone syndrome a cause of postoperative hypocalcemia after total thyroidectomy in thyrotoxicosis? A prospective study with bone mineral density correlation. Surgery. 2018;163(2):367-72.

7. Witteveen JE, van Thiel S, Romijn JA, Hamdy NA. Hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol. 2013;168(3):R45-53.

8. Goltzman D. Physiology of Parathyroid Hormone. Endocrinol Metab Clin N Am. 2018 Dec;47(4):743-758.

9. Ryder CY, et al. Early biochemical response to parathyroidectomy for primary hyperparathyroidism and its predictive value for recurrent hypercalcemia and recurrent primary hyperparathyroidism. Surgery 2021; 169: 120-125.

10. Pavlidis ET, Pavlidis TE. Update on the current management of persistent and recurrent primary hyperparathyroidism after parathyroidectomy. World J Clin Cases. 2023. 6;11

11. Nawrot I, et al. Reoperations for persistent or recurrent primary hyperparathyroidism: results of a retrospective cohort study at a tertiary referral center. Med Sci Monit 2014; 20: 1604-12 [PMID: 25201515.

12. Mizamtsidi M, et al. Diagnosis, management, histology and genetics of sporadic primary hyperparathyroidism: old knowledge with new tricks. Endocr Connect. 2018 Feb;7(2):R56-R68.

13. Ospina N, et al. Outcomes of Parathyroidectomy in Patients with Primary Hyperparathyroidism: A Systematic Review and Meta-analysis. World J Surg. 2016;40(10):2359—77.

14. Rosenbaum MA, Haridas M, McHenry CR. Life-threatening neck hematoma complicating thyroid and parathyroid surgery. Am J Surg. 2008 Mar;195(3):339-43; discussion 343.

15. Joliat GR, Guarnero V, Demartines N, Schweizer V, Matter M. Recurrent laryngeal nerve injury after thyroid and parathyroid surgery: Incidence and postoperative evolution assessment. Medicine (Baltimore). 2017; 96(17):e6674.

16. Steen S, Rabeler B, Fisher T, Arnold D. Predictive factors for early postoperative hypocalcemia after surgery for primary hyperparathyroidism. Proc (Bayl Univ Med Cent). 2009;22(2):124-7.

17. Mazotas IG, Yen TWF, Doffek K, Shaker JL, Carr AA, Evans DB, Wang TS. Persistent/Recurrent Primary Hyperparathyroidism: Does the Number of Abnormal Glands Play a Role? J Surg Res. 2020 Feb;246:335-41.

18. Jakubauskas M, Beiša V, Strupas K. Risk factors of developing the hungry bone syndrome after parathyroidectomy for primary hyperparathyroidism. Acta Med Litu. 2018;25(1):45-51.

19. Ge Y, Yang G, Wang N, Zha X, Yu X, Mao H, Sun B, Zeng M, Zhang B, Xing C. Bone metabolism markers and hungry bone syndrome after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Int Urol Nephrol. 2019 ;51(8):1443-9.

20. Turner J, Gittoes N, Selby P., Society for Endocrinology Clinical Committee. Society For Endocrinology Endocrine Emergency Guidance: Emergency management of acute hypocalcaemia in adult patients. Endocr Connect. 2016;5(5):G7-G8.

21. Anwar F, Abraham J, Nakshabandi A, Lee E. Treatment of hypocalcemia in hungry bone syndrome: A case report. Int J Surg Case Rep. 2018;51:335-39.

22. Florakis D, Karakozis S, Tseleni-Balafouta S, Makras P. Lessons learned from the management of Hungry Bone Syndrome following the removal of an Atypical Parathyroid Adenoma. J Musculoskelet Neuronal Interact. 2019 Sep 01;19(3):379-84.

23. Carsote M, Paduraru DN, Nica AE, Valea A. Parathyroidectomy: is vitamin D a player for a good outcome? Journal of Medicine and Life. 2016;9(4):348— 52.

24. Livschitz J, Yen TWF, Evans DB, Wang TS, Dream S. Long-term Quality of Life After Parathyroidectomy for Primary Hyperparathyroidism: A Systematic Review. JAMA Surg. 2022;157(11):1051–1058.

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Published

01-07-2025

How to Cite

1.
Alexander Kam, Dinda Aprilia, Eva Decroli, Syafril Syahbuddin. Two-Year Follow-Up of Parathyroid Hormone, Calcium, and Vitamin D Serum Levels in a Patient after Parathyroidectomy. InaJEMD [Internet]. 2025 Jul. 1 [cited 2026 May 20];2(1):26-31. Available from: https://inajemd.pbperkeni.or.id/index.php/journal/article/view/Vol2No1-3

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