For which patients with calciphylaxis would you recommend a parathyroidectomy?
In a patient with calciphylaxis and a PTH level of more than 2000 pg/ml, how long would you attempt to get the PTH in goal with medical management before referring for parathyroidectomy?
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In those with refractory hyperparathyroidism (typically PTH above 800-1000 pg/mL) despite medical therapies like cinacalcet.
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In patients with refractory elevated PTH that is not responding to the medical therapy. Having calciphylaxis adds to the indication.
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I would recommend parathyroidectomy in patients with significantly elevated PTH (> 1500-2000?) that does not get controlled with medical management for at least one year. Having had calciphylaxis make it even more important and urgent to go ahead with it.
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It’s too late to treat medically first!
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