Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism

Abstract

Objectives. The aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism.Methods. We studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications.Results. Of the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (<i>P</i><0.01) and 8.0±1.0 mg/dL (<i>P</i><0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism.Conclusion. Subtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.

Efficacy and Safety of Total Parathyroidectomy with Autotransplantation vs. Subtotal Parathyroidectomy for Secondary Hyperparathyroidism: A Retrospective Study

“…Generally speaking, three and a half parathyroid glands are resected in SPTX, and TPTX + AT removes all parathyroid glands and then takes part of the tissue for autologous transplantation [1,24]. However, there are differences in detail.…”

“…We de ned persistent SHPT as elevated iPTH >300pg/ml in any monitoring within 7 days after operation, and recurrent SHPT as iPTH increased >300pg/ml again during follow-up after a successful decrease postoperatively. It should be noted that the de nitions of persistent and recurrent disease vary between literatures [13,[20][21][22][23][24].…”

Efficacy and safety of total parathyroidectomy with autotransplantation vs. subtotal parathyroidectomy for secondary hyperparathyroidism: a retrospective study

“…We de ned persistent SHPT as elevated iPTH >300pg/ml in any monitoring within 7 days after operation, and recurrent SHPT as iPTH increased >300pg/ml again during follow-up after a successful decrease postoperatively. It should be noted that the de nitions of persistent and recurrent disease vary between literatures [13,[20][21][22][23][24].…”

Recent Trends in the Surgical Treatment of Secondary Hyperparathyroidism

“…SPTX was first reported in 1960 and is a technique that removes three and a half glands, leaving about 40-80 mg of normal parathyroid gland tissue. SPTX has been confirmed to be effective in treating SHPT in a recently published paper by Kim et al [5], and tends to be more widely preferred in the United States. In TPTX+AT, the entire parathyroid gland is removed, and then some parathyroid tissue is collected and transplanted into the sternocleidomastoid muscle, trapezius muscle, or brachioradialis muscle.…”