Book contents
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Part 2 Surgical Procedures and their Complications
- Section 17 General Surgery
- Chapter 47 Tracheostomy
- Chapter 48 Thyroidectomy
- Chapter 49 Parathyroidectomy
- Chapter 50 Lumpectomy and mastectomy
- Chapter 51 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- Chapter 52 Small bowel resection
- Chapter 53 Appendectomy
- Chapter 54 Colon resection
- Chapter 55 Abdominoperineal resection/coloanal or ileoanal anastomoses
- Chapter 56 Anal operations
- Chapter 57 Cholecystectomy
- Chapter 58 Common bile duct exploration
- Chapter 59 Major hepatic resection
- Chapter 60 Splenectomy
- Chapter 61 Pancreatoduodenal resection
- Chapter 62 Adrenal surgery
- Chapter 63 Lysis of adhesions
- Chapter 64 Ventral hernia repair
- Chapter 65 Inguinal hernia repair
- Chapter 66 Laparotomy in patients with human immunodeficiency virus infection
- Chapter 67 Abdominal trauma
- Section 18 Cardiothoracic Surgery
- Section 19 Vascular Surgery
- Section 20 Plastic and Reconstructive Surgery
- Section 21 Gynecologic Surgery
- Section 22 Neurologic Surgery
- Section 23 Ophthalmic Surgery
- Section 24 Orthopedic Surgery
- Section 25 Otolaryngologic Surgery
- Section 26 Urologic Surgery
- Index
- References
Chapter 49 - Parathyroidectomy
from Section 17 - General Surgery
Published online by Cambridge University Press: 05 September 2013
- Frontmatter
- Dedication
- Contents
- List of Contributors
- Preface
- Introduction
- Part 1 Perioperative Care of the Surgical Patient
- Part 2 Surgical Procedures and their Complications
- Section 17 General Surgery
- Chapter 47 Tracheostomy
- Chapter 48 Thyroidectomy
- Chapter 49 Parathyroidectomy
- Chapter 50 Lumpectomy and mastectomy
- Chapter 51 Gastric procedures (including laparoscopic antireflux, gastric bypass, and gastric banding)
- Chapter 52 Small bowel resection
- Chapter 53 Appendectomy
- Chapter 54 Colon resection
- Chapter 55 Abdominoperineal resection/coloanal or ileoanal anastomoses
- Chapter 56 Anal operations
- Chapter 57 Cholecystectomy
- Chapter 58 Common bile duct exploration
- Chapter 59 Major hepatic resection
- Chapter 60 Splenectomy
- Chapter 61 Pancreatoduodenal resection
- Chapter 62 Adrenal surgery
- Chapter 63 Lysis of adhesions
- Chapter 64 Ventral hernia repair
- Chapter 65 Inguinal hernia repair
- Chapter 66 Laparotomy in patients with human immunodeficiency virus infection
- Chapter 67 Abdominal trauma
- Section 18 Cardiothoracic Surgery
- Section 19 Vascular Surgery
- Section 20 Plastic and Reconstructive Surgery
- Section 21 Gynecologic Surgery
- Section 22 Neurologic Surgery
- Section 23 Ophthalmic Surgery
- Section 24 Orthopedic Surgery
- Section 25 Otolaryngologic Surgery
- Section 26 Urologic Surgery
- Index
- References
Summary
Parathyroidectomy is performed most commonly in patients with primary hyperparathyroidism and those who are dialysis-dependent and have symptomatic secondary hyperparathyroidism. In patients who have hypercalcemia on dialysis or after renal transplantation (tertiary hyperparathyroidism), operation is also indicated. A physical examination, chest radiograph, and intact parathormone assay distinguish between primary hyperparathyroidism and the hypercalcemia of sarcoidosis, metastases, or a paraneoplastic syndrome. A 24-hour urinary calcium test is occasionally indicated to rule out familial hypocalciuric hypercalcemia. Currently, virtually all preoperative patients undergo localization studies such as cervical ultrasonography, computed tomography with intravenous contrast or radionuclide scanning after the intravenous injection of 99mtechnetium-labeled sestamibi in order to allow for shortened operations through limited incisions. A curative parathyroidectomy not only results in improvements in serum calcium but also improvements in bone density, neuropsychiatric symptoms, calciphylaxis, nephrocalcinosis, nephrolithiasis, and cardiovascular risk.
Preoperative therapy to lower extraordinarily elevated serum calcium levels in patients with parathyroid comas or suspected carcinomas should include saline infusions, furosemide, bisphosphonates and, occasionally, calcitonin. Parathyroidectomy is usually performed under general anesthesia through a low collar incision, although local anesthesia is appropriate for elderly and high-risk patients as well as those undergoing minimally radio-guided parathyroidectomy or image-guided focal exploration.
- Type
- Chapter
- Information
- Medical Management of the Surgical PatientA Textbook of Perioperative Medicine, pp. 507 - 509Publisher: Cambridge University PressPrint publication year: 2013