Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial

Abstract

In a randomized study subtotal parathyroidectomy (sPTX) was compared with total parathyroidectomy and autotransplantation of fresh tissue (PTX + AT) in 40 patients with severe secondary hyperparathyroidism (HPT). After surgery both groups were followed at 19 +/- 6 months (PTX + AT) and 19 +/- 7 months (sPTX) and at 43 +/- 9 months (PTX + AT) and 40 +/- 7 months (sPTX). There were 17 patients alive in each group at the time of the second follow-up. After sPTX, 2 patients required re-operation because of recurrent disease originating from the remaining parathyroid gland in the neck and another 2 patients were hypercalcemic at follow-up. After PTX + AT both serum calcium and alkaline phosphatase normalized significantly more often (p less than 0.03) than after sPTX. Re-operations were not required in this group. Radiological signs also improved significantly more after PTX + AT, as did clinical signs like pruritus (p less than 0.005) and muscle weakness (p less than 0.04). These results and the fact that in recurrent disease a re-operation at the autograft in the forearm is simpler than a re-operation in the neck, lead to the recommendation that PTX + AT should be considered as the method of choice in the surgical treatment of secondary HPT.

Aspectos funcionais e imunológico do transplante autólogo da tireóide em ratos

“…As glândulas paratireóides quando removidas no curso da cirurgia da tireóide, possuem uma alternativa adequada para o implante autólogo 1 .…”

Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons

“…Another advantage is that the site of recurrence can be assessed by a Casanova autograftectomy test [37] or its simplified modification [38]. The only prospective randomized trial comparing the outcome of 40 patients with either subtotal PTX or TPTX+AT showed significantly decreased rates of recurrence, significantly more often normalization of serum calcium and alkaline phosphatase as well as significant improvement of clinical signs like pruritus and muscle weakness after TPTX+AT compared to subtotal PTX [39] (EL IB). However, this RCT was underpowered to lead to standardization of this operative approach.…”

The pattern of the descent of PTH measured by intraoperative monitoring of intact-PTH in surgery for renal hyperparathyroidism

“…The most common surgical procedures used currently to treat renal hyperparathyroidism are subtotal parathyroidectomy and total parathyroidectomy with intramuscular implantation of parathyroid tissue [15]. A small amount of abnormal parathyroid tissue is left in the patient with both techniques.…”

“…In a prospective, randomized, clinical trial, Rothmund et al [15] compared 20 cases of subtotal parathyroidectomy with 20 cases of total parathyroidectomy and intra-muscular autotransplantation followed up for a mean duration of more than 40 months. Hypercalcemia was less frequent and no patient underwent another operation after the latter procedure [16,17].…”