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Patients undergoing parathyroidectomy are usually patients with persistent hyperparathyroidism. This could be due to an adenoma or generalised hyperplasia due to renal failure.
Hypocalcaemia can result immediately following total parathyroidectomy due to development of hypoparathyroidism. This is due to the sudden drop in parathyroid hormone (PTH) levels, further exacerbated by “hungry bones” (skeletal demineralisation) prior to surgery.
Hypocalcaemia following parathyroidectomy will eventually correct itself when the bone has been re-mineralised, although calcium supplements may be needed for 6 to 12 months post-surgery.
Patients with Primary hyperparathyroidism will usually have a Partial parathyroidectomy. They may have a transient drop in their calcium which should respond to the oral protocol below. The hypocalcaemia will usually resolve itself within a few days. They usually require no pre-operative calcium supplementation.
Post-surgery, if calcium levels are 2·0 to 2·2mmol/L give oral supplements of Calvive (formerly called Sandocal) (1 tablet = 25mmol calcium) three times daily. Monitor calcium levels daily until discharge. For calcium levels less than 2mmol/L IV supplementation should be followed as for hypocalcaemia. Patients should have their medication discussed with the consultant endocrinologist prior to discharge.
Patients with Tertiary hyperparathyroidism will usually have a Total parathyroidectomy. They will require oral calcium supplementation pre and post surgery as described below. They may have a dramatic drop in their calcium post-op which is likely to persist. Initial calcium supplementation may therefore need to be given IV as for hypocalcaemia:
- Pre-surgery (for total parathyroidectomy patients only)
- Oral supplements of Calvive (formerly called Sandocal) (1 tablet = 25mmol calcium) three times a day, given outwith mealtimes, and alfacalcidol 2 micrograms daily.
- Both should be given 3 days prior to surgery and continued post-surgery.
- Continue oral supplements of Calvive (formerly called Sandocal) and alfacalcidol as above and monitor adjusted calcium twice daily for the first 2 to 3 days post-surgery and adjust dosages accordingly in discussion with a Renal Physician.
- Renal patients who have undergone a total parathyroidectomy should have their medication discussed with the consultant nephrologists prior to discharge.