Long-Term Outcome after Total Parathyroidectomy for the Management of Secondary Hyperparathyroidism

Abstract

In patients with chronic renal failure, secondary hyperparathyroidism (sHPT) is a common problem requiring surgical parathyroidectomy (PTX) if medical treatment with active vitamin D and calcimimetics fails. To minimize the risk for recurrence, we perform total PTX (tPTX) without autotransplantation. From October 1997 to January 2004, 46 patients (31 men and 15 women) underwent tPTX without autotransplantation (median age 51 years; range 19–80 years; median dialysis time before PTX 5 years; range 0–25 years). Indications for PTX were hyperparathyroid bone disease in 41 cases and calciphylaxis in 5 cases. Postoperatively, all patients were supplemented with vitamin D analogues, both calcitriol and cholecalciferol. Patients were followed up for 4–107 months (median 63 months). Although tPTX was intended in all cases, we saw recurrent or persistent hyperparathyroidism in 26% and supernumerary glands in 15% of cases. In 7 patients (15%), five or more glands were documented and in another four suspected confirming the clinical relevance of intraoperative parathyroid hormone (PTH) measurement. In our study, the positive predictive value of a low intraoperative PTH (<20 pg/ml) for a successful tPTX was 92%. 15 patients received a renal transplant after tPTX without autotransplantation. Here, an uncomplicated hypocalcaemia was noted in 3 patients. Last available calcium levels were between 1.72 and 2.66 mmol/l (median 2.35 mmol/l). After follow-up, active vitamin D was given in a median daily dose of 0.5 μg calcitriol (range 0–2.5 μg/day). There was no evidence of clinical bone disease and no pathological fractures after tPTX after a median observation period of 63 months. tPTX still offers the highest percentage of cure for sHPT, it is safe and postoperatively easily manageable. It allows for adequate supplementation with active vitamin D, and it is the most cost-effective procedure. It should be reconsidered an option for the treatment of sHPT.

Efficacy and its predictor in microwave ablation for severe secondary hyperparathyroidism in patients undergoing haemodialysis

“…Furthermore, none of these patients reported bone pain or pathological fracture. Therefore, these patients may not have developed adynamic bone disease, consistent with the results of previous studies [34,37].…”

“…In contrast, because MWA was not performed under direct vision but under ultrasound guidance some parathyroid tissue was very likely left untreated by this modality. Such residual parathyroid tissue can result in treatment failure or SHPT recurrence caused by disorders of calcium and phosphorus metabolism, and such disorders are very common in patients undergoing haemodialysis [34]. Second, PTX, which has been used to treat SHPT for more than 50 years [35,36], is a well-established surgical procedure.…”

Outcomes of Total Parathyroidectomy with Autotransplantation versus Subtotal Parathyroidectomy with Routine Addition of Thymectomy to both Groups: Single Center Experience of Secondary Hyperparathyroidism

“…As there is no consensus concerning what constitutes adequate iPTH levels in patients with chronic renal failure, the prevalence of late hypoparathyroidism has been defined in the literature as ranging from 3% to 38% (21,22). In our study, late hypoparathyroidism after the operation occurred in three (6%) of 50 patients.…”

Comparative Effectiveness of Paricalcitol versus Cinacalcet for Secondary Hyperparathyroidism in Patients Receiving Hemodialysis

“…This finding is not different from that reported by Gagne et al [19] that showed that as few as one third of parathyroidectomy surgeries were effective long-term, with patients either remaining hypoparathyroid or developing recurrent hyperparathyroidism. Similarly, Stracke et al [27] saw persistent or recurrent hyperparathyroidism in 26% of postparathyroidectomy patients.…”