Primary hyperparathyroidism signs that you may need surgery | Asymptomatic pHPT
TLDRDr. Bob Aaron from the Center for Advanced Parathyroid Surgery addresses the critical considerations for surgery in hyperparathyroidism patients. Highlighting scenarios where surgery is evidently required, such as osteoporosis progression, kidney stones, or malfunctioning kidneys, Dr. Aaron delves into less clear-cut cases, like asymptomatic patients or those with mild symptoms. He reviews the indications for surgery based on international guidelines, emphasizing the importance of comprehensive testing to assess the need for surgery. Dr. Aaron advocates for personalized assessment, particularly for those suffering significant quality of life impacts, and underscores the potential for significant improvement in bone density and symptom relief post-surgery.
Takeaways
- 📚 Hyperparathyroidism surgery indications include osteoporosis progression, fractures from low-impact injuries, kidney stones, and kidney malfunction.
- 🚨 Even without classic symptoms like fractures or kidney issues, surgery may still be considered for hyperparathyroidism based on a comprehensive assessment.
- 🧐 Common symptoms of hyperparathyroidism include fatigue, bone and joint pain, concentration issues, irritability, anxiety, depression, and frequent urination.
- 🔍 Primary care physicians may not immediately consider hyperparathyroidism with symptoms like joint pain and fatigue, highlighting the importance of specialized evaluation.
- ⚠️ The International Guideline for hyperparathyroidism surgery includes specific criteria like calcium levels above normal, bone density indicating osteoporosis, and kidney function markers.
- 🔥 A unit above normal calcium level is a strong indication for surgery, but evidence supporting this as a determinant for surgery's effectiveness is low quality.
- 📏 Bone density studies revealing osteoporosis strongly justify surgery, supported by high-quality evidence of potential reversal of bone loss through surgery.
- 📑 Kidney function and stone formation guidelines provide weaker recommendations for surgery, with low-quality evidence suggesting limited reversibility of kidney damage.
- ⌛️ Long-term studies show that treating hyperparathyroidism can prevent further bone loss and improve bone density, even many years post-surgery.
- 💻 Expert recommendation suggests undergoing comprehensive tests to decisively determine the necessity of surgery for hyperparathyroidism.
- ✅ Patients with hyperparathyroidism impacting their quality of life should seek treatment from expert surgeons who specialize in parathyroid surgery.
Q & A
What are some clear indications for surgery in hyperparathyroidism?
-Clear indications for surgery in hyperparathyroidism include progressive osteoporosis, fractures from low-impact injuries, passing kidney stones, or kidney malfunction.
How can hyperparathyroidism affect a person's quality of life even without severe symptoms like fractures or kidney stones?
-Hyperparathyroidism can significantly affect quality of life through symptoms like fatigue, memory loss, anxiety, body aches, and feeling older, which can impact daily functioning and work.
What are the most common symptoms of hyperparathyroidism?
-The most common symptoms include fatigue, bone pain, joint pain, muscle weakness, concentration issues, irritability, anxiety, depression, sleep problems, increased thirst, frequent urination, stomach acid issues, heartburn, constipation, abdominal pain, incontinence, and nausea.
Why might primary care doctors miss a diagnosis of hyperparathyroidism based on its symptoms?
-Primary care doctors might miss diagnosing hyperparathyroidism because its symptoms, such as joint pain and fatigue, are common to many diseases and are not widely known to be associated with parathyroid disease.
What were the international guidelines on hyperparathyroidism surgery as of 2013?
-The international guidelines from 2013 for hyperparathyroidism surgery recommend surgery based on symptoms like fractures and kidney stones, and other measures including calcium level above the upper limit of normal, osteoporosis on bone density study, kidney malfunction, 24-hour urine calcium over 400, and being under the age of 50.
What is the significance of the calcium level in determining the need for surgery in hyperparathyroidism?
-A calcium level one unit above normal is considered an indication for surgery in hyperparathyroidism, although this is based on low-quality evidence and is somewhat arbitrary without strong scientific proof of its impact.
How does hyperparathyroidism impact bone density, and what is the evidence for surgery based on bone loss?
-Hyperparathyroidism can cause progressive bone loss, with strong scientific evidence showing that surgery can reverse this process and improve bone density, making it a significant indicator for surgery.
What is the recommended approach for asymptomatic patients regarding hyperparathyroidism surgery?
-For asymptomatic patients, the guidelines have shifted towards finding reasons not to do surgery, suggesting comprehensive studies to prove the necessity of surgery, including labs, bone density studies, imaging, and kidney function tests.
Why might a patient with symptoms like fatigue and bone pain but without clear surgical indicators like severe osteoporosis still consider surgery?
-A patient may consider surgery even without clear indicators like severe osteoporosis if the symptoms significantly impair their quality of life and functionality, as treatment can potentially improve these symptoms.
What is the long-term impact of successful parathyroid surgery on bone density?
-Successful parathyroid surgery can lead to an improvement in bone density that lasts for many years, with studies showing bone density can be 10% higher even 15 years after surgery.
Outlines
🔍 Understanding Indications for Parathyroid Surgery
Dr. Bob Aaron, from the Center for Advanced Parathyroid Surgery, addresses the critical question of when surgery is necessary for hyperparathyroidism. The discussion begins with clear-cut scenarios: progressive osteoporosis, kidney stones, and kidney malfunction are straightforward indications. However, the conversation shifts to less obvious cases, exemplified by a 51-year-old woman experiencing fatigue, memory loss, and body aches without the typical severe markers like osteoporosis or significantly elevated calcium levels. Despite her symptoms and slightly abnormal lab results, traditional guidelines might not recommend surgery. Dr. Aaron emphasizes the wide range of symptoms associated with hyperparathyroidism, many of which overlap with other conditions, making diagnosis challenging. He advocates for comprehensive evaluation and considering surgery based on symptom severity and quality of life impact, rather than solely on rigid lab criteria.
📋 Criteria and Evidence for Hyperparathyroidism Surgery
The second paragraph delves into specific criteria for hyperparathyroidism surgery, including osteoporosis, impaired kidney function, high urine calcium levels, and age below 50 as key factors. Despite the presence of these criteria, Dr. Aaron points out the variability and sometimes low-quality evidence supporting them, especially regarding calcium levels' impact on disease severity and kidney function recovery post-surgery. He highlights that preventing disease progression, rather than reversing damage, is often the primary benefit of surgery. Moreover, the guideline shift towards aggressive testing to justify surgery is discussed, with detailed investigations into bone density, kidney function, and potential genetic predispositions recommended. The narrative underscores the nuanced decision-making process in treating hyperparathyroidism, advocating for a tailored approach based on individual patient profiles and symptoms.
🚑 Personalized Approach to Hyperparathyroidism Treatment
The final paragraph centers on a personalized treatment strategy for hyperparathyroidism, using a case study of a 51-year-old woman who doesn't meet traditional surgery criteria yet suffers significantly. Dr. Aaron argues for the importance of assessing the impact of symptoms on patients' lives and suggests that even those not qualifying under strict guidelines may benefit from surgery. He reassures that successful surgery improves bone density and potentially other symptoms. The importance of seeking expert surgical advice is emphasized, along with encouragement for patients to advocate for their health and quality of life. The message concludes with an invitation for viewers to engage with the content through likes, comments, and subscriptions, highlighting the channel's commitment to supporting individuals navigating hyperparathyroidism.
Mindmap
Keywords
💡Hyperparathyroidism
💡Parathyroid surgery
💡Osteoporosis
💡Kidney stones
💡Bone density
💡Calcium levels
💡PTH (Parathyroid Hormone)
💡Symptomatic vs. Asymptomatic
💡Quality of life
💡Evidence-based guidelines
Highlights
Dr. Bob Aaron discusses the indications for treating hyperparathyroidism and the criteria for surgery.
Surgery is considered for patients with osteoporosis, fractures from low impact injuries, kidney stones, or kidney malfunction.
The case study of a 51-year-old woman with fatigue, memory loss, anxiety, and osteopenia but not qualifying for surgery under traditional criteria.
96% of people with hyperparathyroidism complain of fatigue as their most common symptom.
Other common symptoms include bone pain, joint pain, muscle weakness, concentration issues, and depression.
Hyperparathyroidism's symptoms are not exclusively tied to the disorder, making diagnosis challenging.
An international group of specialists updates guidelines on surgery for hyperparathyroidism, last in 2013.
Surgical indications include calcium level one unit above normal, osteoporosis diagnosis, kidney malfunction, or being under the age of 50.
Evidence supporting surgery based on calcium levels alone is considered low quality.
Surgery can reverse osteoporosis caused by hyperparathyroidism.
Treatment may not reverse kidney damage but can prevent further progression.
Kidney stone formation can continue for years after treating hyperparathyroidism, but surgery reduces frequency and severity.
Newer guidelines suggest finding reasons not to perform surgery, advocating for comprehensive testing.
Specialized tests for bone and kidney function are recommended to accurately assess the need for surgery.
Despite not meeting traditional surgical criteria, patients with significant symptoms should consider treatment.
Successful parathyroid surgery improves bone density and potentially other symptoms.
Seek an expert surgeon if hyperparathyroidism affects quality of life, ensuring a specialized approach.
Transcripts
Browse More Related Video
Periodontal Gum Disease and Possibly Going to Lose Your Teeth? Is All on 4 an Option?
Cataract Surgery 2024! Laser & Femto, Multifocal & Light Adjustable Explained!
Coping with Diverticulitis - A Patient's Story
Dental Implants 101: What You NEED to Know! Part 1 (Implant Basics)
Why such a big price difference with All on 4? Dont be bait and switched!
CATARACT SURGERY: Everything you need to know @MichaelRChuaMD
5.0 / 5 (0 votes)
Thanks for rating: