Perioperative care for parathyroid surgery

All patients undergoing parathyroid surgery should avoid excessive calcium intake and maintain good hydration before the operation.

Vitamin D deficiency can exacerbate primary hyperparathyroidism by causing concurrent secondary hyperparathyroidism. If present, correct vitamin D deficiency before surgery with oral colecalciferol. Overcorrection can increase the risk of kidney stones, so avoid a serum 25-hydroxyvitamin D concentration above 100 nanomol/L. See here for more information about vitamin D supplementation.

Hungry bone syndrome is a state of acute onset severe hypocalcaemia (usually with hypophosphataemia) that can occur after successful surgery for hyperparathyroidism (usually tertiary hyperparathyroidism). Patients at particular risk are those with both:

• moderate to severe hyperparathyroidism
• evidence of parathyroid bone disease (eg elevated serum alkaline phosphatase concentration of bone origin, radiological features of hyperparathyroidism, osteoporosis on bone densitometry).

Refer patients at risk of hungry bone syndrome for expert evaluation and care before parathyroid surgery. In patients with tertiary hyperparathyroidism at risk of hungry bone syndrome, a course of preoperative calcitriol is sometimes used by a specialist team to reduce the risk.