Case Of Improvement In Dementia After Hyperparathyroidism Surgery

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A 76-year-old male. The patient with dementia underwent 18F-FCH PET/CT for evaluation of parathyroid adenoma. The transaxial scan image of the neck did not show any abnormalities.

76-year-old patient showed improvement in dementia after undergoing hyperparathyroidism surgery.

This article highlights the case of a 76-year-old Italian male who showed improvement in dementia after hyperparathyroidism surgery. The patient presented to the hospital in a state of delirium. He had a major depressive disorder for over 20 years. Moreover, the patient was currently under treatment for chronic tension headache with analgesics, benzodiazepines, anxiolytics and antidepressants. Doctors diagnosed him with delirium and discharged him on the same day.

Diagnosis and treatment

CT scan of the head was unremarkable. However, laboratory tests revealed mild hypercalcemia. Therefore, doctors advised the patient to undergo Ca level and PTH level tests during the following days. The tests showed increased Ca and PTH values. Doctors, however, admitted the patient again a month later because of disease progression. The patient presented with mild ataxia while walking, rigidity, palmar hyperhidrosis, mirror movements, postural tremors and dysarthria. Doctors suggested for him to stop taking the antidepressants, anxiolytics, and benzodiazepines, because of sleep disturbances. Although, he did not show any improvements.

For further evaluation he underwent several clinical diagnostic tests. The tests including bone marrow test, tau protein and 14.3 dosage, electroencephalography, thyroid ultrasound, CT scan of the neck and abdomen, CT scan and magnetic resonance imaging of the head, and whole-body 18 FDG Positron Emission Tomography/Computed Tomography (PET/CT) showed no pathologies. Doctors administered 30 mg immunoglobulin G (IgG) EV per day for 5 days. The patient was diagnosed with a degenerative disease.

After almost two years neck ultrasound identified enlarged parathyroid glands. The patient was advised surgery and three parathyroid glands were removed. Parathyroidectomy and lithium treatment showed improvement in cognitive functions. In elderly patients, as in this case, cognitive dysfunction may mask the underlying primary hyperparathyroidism.

The patient’s thyroid function was restored within the next few weeks. However, there was no improvement in cognitive impairment. His headaches, difficulty sleeping and depression. also improved considerably after two months of therapy.

References

Dementia Improvement after Primary Hyperparathyroidism Surgery https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7333033/

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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