Subtotal Parathyroidectomy vs Total Parathyroidectomy with Autotransplantation for Secondary Hyperparathyroidism in Dialysis Patients: Short- and Long-Term Outcomes

Zmijewski, Polina; Staloff, Jonathan; Wozniak, Madeline J.; Mazzaglia, Peter J.

doi:10.1016/j.jamcollsurg.2019.01.019

Cited by 24 publications

(16 citation statements)

References 19 publications

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“…69,166,260,266,277,420,421 Intravenous calcium gluconate is generally added when serum calcium levels fall below a specific threshold, although some advocate for immediate administration based upon alkaline phosphatase levels. 198,266,277,420,421 For patients on hemodialysis, a high calcium bath can also be employed. 372,419 Calcimimetic medications should be immediately discontinued due to the risk of hypocalcemia.…”

Section: Postoperative Hypocalcemia and Treatment Protocolsmentioning

confidence: 99%

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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Objective: To develop evidence-based recommendations for safe, effective, and appropriate treatment of secondary (SHPT) and tertiary (THPT) renal hyperparathyroidism. Background: Hyperparathyroidism is common among patients with chronic kidney disease, end-stage kidney disease, and kidney transplant. The surgical management of SHPT and THPT is nuanced and requires a multidisciplinary approach. There are currently no clinical practice guidelines that address the surgical treatment of SHPT and THPT. Methods: Medical literature was reviewed from January 1, 1985 to present January 1, 2021 by a panel of 10 experts in SHPT and THPT. Recommendations using the best available evidence was constructed. The American College of Physicians grading system was used to determine levels of evidence. Recommendations were discussed to consensus. The American Association of Endocrine Surgeons membership reviewed and commented on preliminary drafts of the content. Results: These clinical guidelines present the epidemiology and pathophysiology of SHPT and THPT and provide recommendations for work-up and management of SHPT and THPT for all involved clinicians. It outlines the preoperative, intraoperative, and postoperative management of SHPT and THPT, as well as related definitions, operative techniques, morbidity, and outcomes. Specific topics include Pathogenesis and Epidemiology, Initial Evaluation, Imaging, Preoperative and Perioperative Care, Surgical Planning and Parathyroidectomy, Adjuncts and Approaches, Outcomes, and Reoperation. Conclusions: Evidence-based guidelines were created to assist clinicians in the optimal management of secondary and tertiary renal hyperparathyroidism.

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Section: Postoperative Hypocalcemia and Treatment Protocolsmentioning

confidence: 99%

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Dream

Kuo

et al. 2022

Annals of Surgery

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“…The most effective and safe treatment method for patients with secondary hyperparathyroidism is total parathyroidectomy and parathyroid autotransplantation [14][15]. The first successful parathyroidectomy was performed in 1928 by Isaac Y. Olch for bilateral parathyroid adenoma in America and later in 1932 by Cope and Churchill for bilateral neck exploration [5].…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of the Gamma Probe in Childhood Parathyroidectomy: Retrospective Study

Çağlar

Ötgün

Cömert

et al. 2020

Cureus

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Background There are few reports about parathyroidectomy due to secondary hyperparathyroidism in patients with end-stage renal failure in the literature. We aimed to evaluate the surgical treatment methods and the results of patients who were operated for secondary hyperparathyroidism with end-stage renal disease in our center. Method Sixteen patients with the diagnosis of secondary hyperparathyroidism were treated surgically in our center. Demographical data, laboratory findings, and imagining methods were all examined. The effect of the Technetium 99m methoxyisobutylisonitrile (Tc-99m-MIBI) probe sensitive to gamma rays detection was also evaluated to locate and identify all the parathyroid glands during the operation. Results Eleven of the patients underwent intravenous (IV) Tc-99m MIBI preoperatively and a gamma probe was detected during surgery. The gamma probe was not used in five patients. Four parathyroid glands were removed in eight (72.7%) out of 11 patients with gamma probes and three parathyroid glands were found in three patients. Total parathyroidectomy and parathyroid autoimplantation were made to eight patients who had removed four glands, subtotal parathyroidectomy was done for the other patients. On a comparison of laboratory findings before and after the surgery, there was a significant relationship between the decrease of serum parathyroid hormone and calcium levels (p<0.05). Conclusion Total parathyroidectomy and parathyroid autoimplantation is the most efficient and safe mode of management for secondary parathyroidism patients. During the surgery, using a probe sensitive to gamma rays detection may also help the surgeon. Thus, unnecessary dissections to prevent the presence of atypical parathyroid glands are prevented.

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“…This procedure avoids postoperative hypocalcemia, is more effective at improving quality of life than PTX alone, and the iPTH level is not affected by the quantity and quality of graft fragments ( 43 )( Table 1 ). However, a limitation of this procedure is that autologous parathyroid transplantation may lead to HPT recurrence ( 52 ), but the persistence and recurrence probability of HPT are much less than sPTX ( 41 , 42 )( Table 1 ). Thus, some experts recommend tPTX-AT as the preferred surgical management method for SHPT, because reoperation at the forearm autograft site is simpler than in the neck after sPTX ( 43 ).…”

Section: Treatment For Hptmentioning

confidence: 99%

Advances in the treatment of secondary and tertiary hyperparathyroidism

et al. 2022

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Secondary hyperparathyroidism (SHPT) and tertiary hyperparathyroidism (THPT) are common and complicated clinical endocrine diseases. The parathyroid glands maintain endocrine homeostasis by secreting parathyroid hormone to regulate blood calcium levels. However, structural alterations to multiple organs and systems occur throughout the body due to hyperactivity disorder in SHPT and THPT. This not only decreases the patients’ quality of life, but also affects mortality. Since current treatments for these diseases remains unclear, we aimed to develop a comprehensive review of advances in the treatment of SHPT and THPT according to the latest relevant researches.

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Subtotal Parathyroidectomy vs Total Parathyroidectomy with Autotransplantation for Secondary Hyperparathyroidism in Dialysis Patients: Short- and Long-Term Outcomes

Cited by 24 publications

References 19 publications

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

The American Association of Endocrine Surgeons Guidelines for the Definitive Surgical Management of Secondary and Tertiary Renal Hyperparathyroidism

Effectiveness of the Gamma Probe in Childhood Parathyroidectomy: Retrospective Study

Advances in the treatment of secondary and tertiary hyperparathyroidism

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