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The calcitonin levels can sometimes mislead parathyroid surgeons in patients with chronic kidney disease and renal hyperparathyroidism: report of a case

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Abstract

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.

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Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the authors.

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The authors declare that they have no competing interests.

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Authors and Affiliations

  1. Department of Visceral, Thoracic and Vascular Surgery, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Ralph Schneider, Detlef K. Bartsch & Katja Schlosser

  2. Department of Gastroenterology, Philipps University Marburg, Baldingerstrasse, 35043, Marburg, Germany

    Johanna E. Schaumburg

Authors
  1. Ralph Schneider
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  2. Johanna E. Schaumburg
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  3. Detlef K. Bartsch
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  4. Katja Schlosser
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Correspondence to Ralph Schneider.

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Schneider, R., Schaumburg, J.E., Bartsch, D.K. et al. The calcitonin levels can sometimes mislead parathyroid surgeons in patients with chronic kidney disease and renal hyperparathyroidism: report of a case. Surg Today 43, 429–433 (2013). https://doi.org/10.1007/s00595-012-0131-y

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  • DOI: https://doi.org/10.1007/s00595-012-0131-y

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