Surgery Of Parathyroid Flashcards
Commonest HPT type
Primary
Commonest cause of primary HPT?
Adenoma, solitary or multiple.
What is the site of adenoma in the PT?
Lower PTs
How do we diagnose a hyper-calcemic crisis?
Ca> 16mg/dl
Why do we do a plain x-ray?
To visualize osteoporosis or other bone deformities, like the moth-eaten lesions of the skull. Or, Kyphoscoliosis of the chest.
What is the PXR urinary tract visualization of HPT?
A Stag horn stone
Along with a PXR, what other studies do we do?
IVU and CT, to assess renal function and to rule out other causes of hypercalcemia
When it comes to localized studies, explain the only Pro nuclear imaging has over US
The detecting of Ectopic Adenomas.
What is the Nuclear imaging called?
Technetium-Thalium subtraction. (TTS), MIBI is also an option (Technetium Sestamibi)
How do we treat the Hyperplasia cause of HPTH?
Subtotal Thyroidectomy
How do we treat the Adenoma cause of HPTH?
Excision of affected gland only
How do we treat the Carcinoma cause of HPTH?
excision of tumor, ipsilateral thyroid lobe and palpable lymph nodes. And Radiotherapy to prevent recurrence
What is the half life of PTH?
5 mins
Explain the Intraoperative PTH monitoring process
Removal of the abnormal PT gland drops the PTH rapidly, so we sample before, at 5 mins and 10 mins after excision. It is confirmed as cured if there is 50% reduction of PTH compared to the high pre-excision level
Secondary HPTH is defined as what?
Parathyroidal hypertrophy and excess PTH production in response to hypocalcemia.
Causes of Secondary HPTH?
Renal disease, Malabsorption, and Osteomalacia caused by VIT D deficiency
Clinical picture of Secondary HPTH
Low serum calcium and bone changes, but unlike primary, no bone cysts.
In most cases, secondary HPTH will heal when CA is raised via?
VIT D metabolites and Calcium supplements
Surgical treatment of Secondary HPTH?
Subtotal or total parathyroidectomy
Main indications of surgical treatment for 2ry HPTH?
symptomatic, like bone pain and such.
What is 3ry HPTH?
When the 2ry HPTH becomes long standing.
Hypoparathyroidism has what signs?
Tetany, nervous changes, so on
