AAES GUIDELINES 8:
POST-OPERATIVE CARE/CURE AND FAILURE
RECOMMENDATION: After successful parathyroidectomy, patients should receive calcium supplements and/or dietary calcium according to the Institute of Medicine Dietary Reference Intakes.
COMMENT: After successful parathyroidectomy, the body needs an increased calcium intake to aid bone remineralisation
RECOMMENDATION: After apparently successful parathyroidectomy, patients who are 25-OH vitamin D deficient should be supplemented to sufficient levels. Once 25-OH vitamin D levels are normalized, patients should be advised to take vitamin D according to the Institute of Medicine Dietary Reference Intakes.
COMMENT: As per the previous recommendation, Vitamin D is essential to aid calcium absorption
RECOMMENDATION: At 6 months, surgeons individually or in conjunction with the multidisciplinary care team should assess post-parathyroidectomy patients for cure and evidence of long-term complications.
COMMENT: Persistent hyperparathyroidism due to a missed extra adenoma can take 6 months to present, so measurement of the serum calcium should always be performed at that time.
RECOMMENDATION: Cure after parathyroidectomy for pHPT is defined as the reestablishment of normal calcium homeostasis lasting a minimum of 6 months. Patients who are normocalcemic with persistent PTH elevation after parathyroidectomy for pHPT should be evaluated and treated for causes of secondary HPT and if none are present, monitored for recurrent disease at least annually.
COMMENT: n about a third of patients the PTH levels will rise again after surgery and remain elevated for 6 to 12 months. This is most likely due to the other glands working harder to aid increased calcium resorption and bone remineralisation. It is not usually of concern and just needs to be checked again at 12 months . If the PTH fails to normalize then at that stage investigation for an extra missed adenoma should be undertaken.
RECOMMENDATION: Long-term cure rates for parathyroidectomy in sporadic pHPT should approach 95-99%
COMMENT: This is the benchmark and if a surgeon is not meeting it, a revised operative approach, such as changed indications in his or hands for MIP, should be considered.