Therapeutic efficacy of two surgical methods on the secondary hyperparathyroidism

Abstract

Background: This study aimed to investigate the clinical efficacy of two surgical methods on hyperparathyroidism secondary to uremia and summarize the advantages and disadvantages of both methods.Methods: Uremic patients who received parathyroidectomy (PTX) in the last 3 years were divided into two groups according to the surgical methods used [subtotal parathyroidectomy (SPTX) group and total parathyroidectomy + autologous implantation (TPTX + AT) group]. TPTX was performed if less than 4 glands were found during surgery. The changes of various indexes after operation, and calculate the success rate and recurrence rate of patients were observed. The serum biochemical parameters were routinely monitored, the success rate, postoperative complications and recurrence were recorded. The patients were followed up.Results: There were 20 patients in the SPTX group and 12 in the TPTX + AT group. The success rate of surgery was 85% and 91.7% in the SPTX group and TPTX + AT group, respectively, among 32 patients included for final analysis. The mean PTH and postoperative ALP in the TPTX + AT group were slightly lower than in the SPTX group, except for the PTH levels at 6 months after surgery (P<0.05). The incidence of postoperative hypocalcemia was 100% in both groups. The incidence of wound infection in the two groups was 0% and 16.7% in the SPTX group and TPTX + AT group, respectively. The mean calcium supplementation in the TPTX + AT group was significantly more than in the SPTX group within 1 year after surgery. The mean postoperative bone mineral density in the SPTX group was significantly higher than in the TPTX + AT group. The time to postoperative remission of bone pain and muscle weakness was markedly shorter in the SPTX group than in the TPTX + AT group. The post-operative quality of life (QOL) in the SPTX group was significantly better than in the TPTX + AT group.Conclusions: These findings suggest that SPTX achieves a better short-term efficacy, but TPTX + AT has a better long-term efficacy. Therefore, the selection of surgical method for PTX may be based on the age, estimated survival time and possibility of kidney transplantation.

Association Between Treatment of Secondary Hyperparathyroidism and Posttransplant Outcomes

“…In contrast, parathyroidectomy is an effective method for long-term control, significantly lowering PTH levels into the normal laboratory reference range (<65 pg/mL) in 90%-100% of patients. 10,11 However, parathyroidectomy is typically reserved for patients with refractory SHPT or those unable to tolerate calcimimetics even though it results in a greater drop in PTH levels. 12,13 Furthermore, studies have demonstrated an association between severity of SHPT pre-KT and higher rates of post-KT graft failure and persistent hyperparathyroidism, also known as tertiary hyperparathyroidism (THPT).…”

“…In contrast, parathyroidectomy is an effective method for long-term control, significantly lowering PTH levels into the normal laboratory reference range (<65 pg/mL) in 90%–100% of patients. 10,11 However, parathyroidectomy is typically reserved for patients with refractory SHPT or those unable to tolerate calcimimetics even though it results in a greater drop in PTH levels. 12,13…”

Secondary Hyperparathyroidism in Dialysis Patients: Short- and Long-Term Outcomes of Conservative Parathyroidectomy

“…Currently, the selection of a surgical approach relies on the surgeon's discretion and the clinical characteristics of the patients [33].…”

Management of pre-renal transplant secondary hyperparathyroidism: parathyroidectomy versus cinacalcet

“…PTX is an excellent long-term management strategy because it reduces PTH levels below the standard laboratory reference range in the majority of patients. 9 , 10 …”