3• Parathyroid Disorders slideshow [Slides].pdf

Thyroid disorder

1. Parathyroid
Disorders

2. Diagnostic Approach to
Hyperparathyroidism
Obtain
Calciumand Phosphate
PossiblePrimaryor Tertiary Hyperparathyroidism Possible Secondary Hyperparathyroidism
↑Calcium
↓Phosphorus
↓Calcium ↑Phosphorus
Obtain
PTH, Vitamin Dand BMP
Primaryvs FHHTertiary Hyperparathyroidism
Obtain
Urine Calcium
Primary FHH
↑Urine calcium ↓Urine calcium
Secondary Hyperparthyroidism
CKD Vitamin D deficiency
↓↓GFR ↓↓Vitamin D
↑PTH
Obtain
PTH, Vitamin Dand BMP
↑↑PTH ↓↓GFR ↑PTH
Normal GFR
Obtain
Thyroid U/Sor Sestamibi Scanor CT scan
Obtain
DEXA scanand Renal U/S

3. Treatment of
Hypoparathyroidism
Type Purpose of TreatmentTreatment
Hypo-
parathyroidism
Replete Calcium -Calcium and Vit D
Replete Magnesium-Magnesium
Increase PTH -Recombinant PTH
Hypoparathyroidism
IV Calcium Oral Calcium and Vitamin D
Calcium <7.5 or symptoms Calcium >7.5
Monitor for calcium stones
Recombinant PTH
Refractory

4. Treatment of
Hyperparathyroidism
Type/
Complication
Purpose of Treatment Treatment
1°or 3°Hyper-
parathyroidism
Remove parathyroid-Parathyroidectomy
Suppress PTH -Cinacalcet
Suppress bone injury-Bisphosphonates
2°Hyper-
parathyroidism
Treat CKD
-Sevelamer
-Calcium and Vit D
Treat Vit D deficiency-Vit D
Severe
Hypercalcemia
( > 14)
Lower serum calcium
-IV normal saline PLUS
-Bisphosphonates PLUS
-Calcitonin
1°or 3°Hyperparathyroidism
Calcium > 11.5?
Renal Involvement
-CKD 3 or worse?
-Hypercalciuria?
-Nephrolithiasis?
PLUS
Skeletal Involvement
-BMD < -2.5or Fractures?
PLUS
Perform
Parathyroidectomy
Surgical candidate
Cinacalcet
Not a surgical candidate
Bisphosphonates Slow Progression
2°Hyperparathyroidism
Hyperphosphatemia?
Add Sevelamer
Hypocalcemia?
Add Calcium
and Vitamin D
CaR
Calcimimetics: Cinacalcet
Cinacalcet
Ca
Parathyroid Cell
PTH synthesis &
secretion