Obstacles and Possibilities in the Evaluation of Surgical Treatment for Lithium-Associated Hyperparathyroidism Through a Randomized Controlled Trial

Abstract

Randomized controlled trials are often considered in medical circles to be the golden standard for the execution and evaluation of clinical studies. In practice, however, relatively few are performed due to a series of factors including ethical, financial, and organizational. For the clinician, the challenges can be multiple. There exists today limited knowledge concerning lithium-associated hyperparathyroidism. Whether the condition is significantly different from primary hyperparathyroidism is a point of considerable contention. In this case study, we report the experiences of clinicians responsible for the creation and implementation of the first randomized controlled trial of radical surgery of lithium-treated patients who develop hyperparathyroidism, discussing both methodological and epistemological obstacles.

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