This document summarizes the medical history and treatment of a 55-year-old male patient with end-stage renal disease on hemodialysis for 17 years and secondary hyperparathyroidism. Medical treatment with cinacalcet and calcitriol was unsuccessful in lowering his high calcium, phosphorus, and PTH levels. Consultations with ENT and cardiology found no issues. The doctor decided that parathyroidectomy was the best option to treat his tertiary hyperparathyroidism that was not responding to medical treatment.

1. Dr. Alshimaa Fathy
Nephrology fellowship doctor
New Mansoura General Hospital

2.  55year old male patient named Abd El
Razek from Kafr ELgazar, married, has 5
offspring , works as agriculture engineer,
no special habits,DM 2 years ago,HTN 20
years,HCV+ve
Personal history

3. Complaint
Sever Bone ache 2 years ago.

4. Present history
 ESRD on Hemodialysis 17 Y ago with 3
session/w and take 4 hour every session.
 High Ca and Ph concentration and very high
PTH.

5. Trial of medical treatment
 Cinacalset 2tab /day for 1 moth .
 Alfa calcidol ampule 3times every weak.
 Pth

6. ca po4 pth
2-
2018
9,6 6 2603
4-
2018
10,5 5,8 2350
7-
2018
10,9 4,8 2242

7. Pre-operative Lab
 PTH :
 ALT : 35 , AST :
 Creat. : , Urea :
 Na : , K :
 Ca : , Po4 :
 WBC : , HGB :
 PLAT. : , INR :
 Alb. :
 Ph : , Hco3 : ,
Pco2 :

8. Consultations
* ENT Consultant :
Mobile both vocal cord
* Cardiac Consultant :
No past history of cardiac op . .
On exam.
BP 146/90
HR 100
Chest normal vesicular breath sound
,
Echo EF65% mild AR,moderateMR,calcified mitral vave cusps
,PR

9. Decision
 Parathyroidectomy IS the best option for ttt of
tertiary hyperparathyroidism not responding to
medical ttt