Subtotal Resection of Parathyroids Preserving an Intact Parathyroid in Patients with Tertiary Hyperparathyroidism

Abstract

Introduction: Parathyroid hormone, is one the controllers of calcium homeostasis, is synthesized and secreted by the parathyroid glands. They can become hyper functioning, generate excessive amounts of PTH, and determine the clinical-laboratory picture called hyperparathyroidism. When hyperparathyroidism is a consequence of a pre-existing metabolic imbalance, it is called secondary. Secondary hyperparathyroidism is thus an acquired disorder represented by parathyroid hypersecretion in response to calcium homeostasis disorders. Chronic kidney disease is a condition often associated with secondary hyperparathyroidism. It is a heterogeneous disorder characterized by varying degrees of stimulation and suppression of PTH, being associated with hyperplasia of the parathyroid glands. Material and Method: The present study is a historic prospective cohort analysis of patients undergoing subtotal parathyroidectomy, keeping a parathyroid gland intact in its bed, by tertiary hyperparathyroidism. Result: 44 patients between 30 and 75 years of age were selected, with a median of 49.5 years for the group, divided equally between men and women. Conservative treatment time was 36.75 months and hemodialysis time was 67.33 months. Renal transplantation time was 42.64 months, with PTH value on the day of renal transplantation of 822.03 pg/mL. On the day of surgery, the PTH value was 170.9 pg/mL, reaching an average value of 77.2 after 5 years. The initial value of ionic calcium was 1.477 mmol/L and a final value of 1.299 mmol/L after 5 years. Conclusion: The evaluation of the present study allows us to conclude that subtotal parathyroidectomy, keeping a parathyroid gland intact in its bed, is a safe and effective technical option in the surgical treatment of patients with tertiary hyperparathyroidism.