PMC9758555_01
Treatment of hypercalcemia prior to parathyroidectomy.. IV, intravenous
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Subcutaneous calcitonin 300 units every 12 hours and a single dose of IV pamidronate 90 mg were also administered (Figure 1). He required a dose of zoledronate 4 mg IV within one week of pamidronate administration to keep serum corrected calcium <3.0 mmol/L (Figure 1).
Complications of primary hyperparathyroidism. (a) Radiograph of both hands showing subperiosteal bone resorption at the radial aspects of the proximal and middle phalanges (solid arrows) and at the tufts of the distal phalanges (dotted arrows). (B) Axial contrast-enhanced computerized tomography scan of the kidneys showing bilateral non-obstructing calyceal calculi.
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Further investigations revealed complications of hyper-parathyroidism (Figure 2).
Pre-parathyroidectomy localization studies. (a) Ultrasonography of the parathyroid glands demonstrating a 2.7 cm x 1.8 cm x 1.8 cm well-defined hypoechoic nodule located posterior to the right lower pole of the thyroid gland. A characteristic polar vessel is seen (white arrow). (B) Parathyroid sestamibi scan demonstrating a focus of intense tracer uptake with delayed washout projected at the lower pole of the right thyroid lobe consistent with a hyperfunctioning right inferior parathyroid nodule (white arrow).
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He underwent preoperative localization of the lesion with a neck ultrasonography (US) and technetium-99m sestamibi parathyroid scan (Figure 3).
Post-parathyroidectomy management of hypocalcemia.. 25OH Vit D, 25-hydroxyvitamin D; BD, twice daily; iPTH, intact parathyroid hormone; IV, intravenous; PO, per orem; POD, postoperative day; TDS, three times daily.
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TDS and calcitriol 1 microg BD (Figure 4). The oral medications were gradually tapered to calcium carbonate 1.25 g BD and cholecalciferol 1000 units OM over the next three months during his inpatient rehabilitation.