Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35043 Marburg, Germany.
Surg Today. 2013 Apr;43(4):429-33. doi: 10.1007/s00595-012-0131-y.
Renal hyperparathyroidism (rHPT) as a consequence of an abnormal calcium balance is a frequent complication in patients with chronic kidney disease (CKD). However, calcium homeostasis is also regulated by calcitonin. The relevance of elevated calcitonin levels in patients with rHPT is unclear. This report presents a case of a patient with CKD and mild rHPT scheduled for thyroidectomy for a suspected medullary thyroid carcinoma (MTC) within a mononodular goiter. A hemithyroidectomy with resection of both adjacent parathyroid glands and unilateral central lymph node dissection was performed. Histopathology revealed no evidence of MTC. The rHPT, calcitonin and pentagastrin test subsequently normalized and follow-up revealed no evidence for MTC within the remaining right thyroid lobe. Elevated calcitonin levels in patients with CKD may reflect a physiological response to rHPT than rather represent MTC. The thresholds for calcitonin levels need to be better defined in affected patients to determine the optimal extent of surgical resection.
肾性甲状旁腺功能亢进症（rHPT）是慢性肾脏病（CKD）患者钙平衡异常的常见并发症。然而，钙稳态也受降钙素调节。高钙血症在 rHPT 患者中的相关性尚不清楚。本报告介绍了一例 CKD 合并轻度 rHPT 的患者，因怀疑患有甲状腺髓样癌（MTC）而在单结节性甲状腺肿中进行甲状腺切除术。行单侧甲状腺次全切除术，切除双侧相邻甲状旁腺和单侧中央淋巴结清扫术。组织病理学检查未发现 MTC 证据。rHPT、降钙素和五肽胃泌素试验随后恢复正常，随访发现右侧剩余甲状腺叶内无 MTC 证据。CKD 患者降钙素水平升高可能反映了对 rHPT 的生理反应，而不是代表 MTC。需要在受影响的患者中更好地定义降钙素水平的阈值，以确定手术切除的最佳范围。
