Case Report: KINH NGHIỆM TỪ CA PHẪU THUẬT CẮT GẦN HOÀN TOÀN TUYẾN CẬN GIÁP ĐIỀU TRỊ CƯỜNG CẬN GIÁP THỨ PHÁT ĐANG LỌC MÁU CHU KỲ TẠI BỆNH VIỆN QUÂN Y 175

Vinh Ngô Trọng; Nam Võ Thành Hoài; Hà Phan Thị Thu; Phương Đặng Thanh; Bình Nguyễn Công; Minh Dương Xuân; Hằng Phạm Thị Ngọc; Thanh Lê Thị; Thúy Lê Thị Thu; Tân Lê Minh

Keywords:

Secondary hyperparathyroidism, Hemodialysis, Hungry Bone Syndrome, Mineral Bone Disease, ESRD, parathyroidectomy

Abstract

For the first time, at Military Hospital 175, the Department of Nephrology - Dialysis coordinated with the Department of Thoracic Surgery operating subtotal parathyroidectomy to treat secondary hyperparathyroidism in a hemodialysis patient. Parathyroidectomy in dialysis patients was expected to stop progression of mineral bone disease, decrease phosphatemia, increase bone density, decrease calciphylaxis and increase survival rate. Total or near total parathyroidectomy is required to reduce the incidence of recurrent hyperparathyroidism and re-surgery. Postoperative PTH decreased rapidly, causing excessive and prolonged hypocalcemia, manifested as Hungry Bone Syndrome (HBS). Our case was planned to be closely monitored after surgery, calcitriol added with calcium supplementation orally and intravenously. HBS occured immediately after surgery, there was no clinical manifestations, detected and monitored only by plasma calcium concentration. Prolonged intravenous calcium supplementation was detrimental due to peripheral thrombophlebitis. Postoperative sepsis associated with dialysis is a hindrance to the diagnosis and acute managements.

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