Ask the Experts

  1. Hossam Galal
  2. Metabolic Bone Disease and SHPT
  3. Wednesday, 03 September 2014
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Dear Dr Jordans and all colleagues
i would like to ask if there is any guidelines for chronic vitamin D therapy in dialysis patients who had history of parathyroidectomy (not acute management )
the labs of such patients is similar to adynamic bone disease with low PTH, high Po4, differ only in ca level that will be low or normal
but if they receive vitamin D they will be very similar to Adynamic bone disease group but then how they will be treated as they do not have PTH to stimulate
thanks in advance for help
Responses (2)
Accepted Answer Pending Moderation

In my opinion, I would supplement patients post-parathyroidectomy (PTX) with low dose activated Vitamin D3, assuming phosphate is relatively well controlled. Patients whose PTH is suppressed by calcium and vitamin D are at risk for adynamic bone disease. So a patient who can make PTH but does not because of calcium and Vitamin D administration should have those medications reduced or removed. However, patients who have very low PTH hormone post PTX can't make PTH in many cases or make very little, depending on how much tissue was removed. In that case, the vitamin D and calcium are not playing the same role in suppressing it's production to low levels. And remember, Vitamin D has many potential (albeit unproven) benefits beyond PTH suppression, and therefore supplementation despite low PTH post-PTX should be considered.

Dr. Jordan Weinstein
Accepted Answer Pending Moderation
Its often difficult to maintain serum ca in normal limits among these pts post parathyroidectomy, without active Vit D, even months to years after their surgery.
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