Parathyroid Carcinoma Follow-up

Updated: Dec 01, 2015
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Jules E Harris, MD, FACP, FRCPC  more...
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Follow-up

Further Outpatient Care

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  • After surgical treatment, periodic follow-up with serum calcium determinations is mandatory. If serum calcium begins to rise, elevation of parathyroid hormone level can confirm recurrence.
  • Once suspected, the location of the recurrence should be determined.
    • Neck imaging with CT scan, MRI, or ultrasound is indicated.
    • PET scanning may detect distant metastases but its accuracy in this disease is not clearly defined.
    • A chest radiograph is indicated, but a chest CT scan may reveal pulmonary metastases missed on plain radiograph.
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Further Inpatient Care

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  • Inpatient care is usually limited to the perioperative period or to treating refractory hypercalcemia.
  • Occasionally, other complications such as pathologic fractures may require hospitalization.
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Inpatient & Outpatient Medications

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  • Medical therapy is limited to the control of hypercalcemia (if necessary).
  • Most of the time, volume expansion with normal saline and diuresis with furosemide is adequate treatment.
  • The bisphosphonates may also be used for short-term control of the hypercalcemia but often are ineffective in long-term control in patients with metastatic disease.
  • Calcitonin may be used for short periods, usually in conjunction with a bisphosphonate. It usually loses effectiveness rapidly.
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Transfer

Because parathyroid carcinoma is rare, transfer to a tertiary care facility is warranted. This concentration of experience may hasten our understanding of this rare disease.

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Deterrence/Prevention

No preventive measures to guard against this disease are known.

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Complications

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  • See complications outlined in Hyperparathyroidism.
  • Hypercalcemia is found in patients with untreated or inadequately treated parathyroid carcinoma. It is often the mechanism of death in patients with metastatic disease.
  • Postoperative hypocalcemia can be severe because of bone hunger syndrome.
  • In patients with severe bone disease, falling presents a serious hazard in the form of pathologic fractures.
  • Injury to the recurrent nerve at the time of operation may be unavoidable in some cases because of direct invasion by the tumor.
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Prognosis

Recurrence and death are quite common. Disease recurs after the initial operation in more than two thirds of patients. Recurrence is often delayed, sometimes for more than 20 years.

Overall, 5-year survival rate is 50-70%, but many die after 5 years. In one large series, median survival was greater than 14 years. [32] Often, death from other causes intervenes so death from parathyroid carcinoma may be relatively uncommon.

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Patient Education

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  • Discuss the prognosis associated with the disease and its relationship to hypercalcemia.
  • Make patients aware that surgery is the only effective treatment against the tumor itself even though medical therapy may alleviate the hypercalcemia.
  • Emphasize the difficulty of diagnosis. Discuss the long-term nature of the disease even with metastases.
  • Educate the patient and family about fall prevention. This is more important as bone disease is more severe.
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