Severe Secondary Hyperparathyroidism in a Hemodialysis Patient: A Case Report from Mongolia

Secondary hyperparathyroidism (SHPT) occurs in patients with chronic renal failure complicated with renal bone disease and soft tissue/vascular calcification. In dialysis patients with severe SHPT, medical treatment may fail and parathyroidectomy (PTX) is indicated for definitive treatment. Severe hypocalcemia from hungry bone disease or postoperative hypoparathyroidism may occur during the postoperative period. We report here a case of severe SHPT in a hemodialysis patient treated with phosphate binders, calcitriol, and calcimimetics but who still required PTX. Severe hypocalcemia with muscle cramps occurred postoperatively. Around 1 year after PTX, anemia and features of SHPT have improved but the patient still has intermittent hypocalcemia with suspected postoperative hypoparathyroidism. Regular comprehensive assessment of calcium and phosphorus levels throughout all stages of chronic kidney disease is vital. The postoperative period of PTX in SHPT patients is critical, requiring monitoring to improve management.