Total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation as the treatment of choice for secondary hyperparathyroidism: a single-center experience

Abstract

BackgroundThe aim of the study was to evaluate total parathyroidectomy with trace amounts of parathyroid tissue (30 mg) as a surgical option in secondary hyperparathyroidism (sHPT) treatment.MethodsFrom January 2008 to March 2012, 47 patients underwent parathyroidectomy. Comparisons of demographic data, symptoms, and preoperative or postoperative biochemistry were made between total parathyroidectomy with trace amounts of parathyroid tissue autotransplantation group and total parathyroidectomy group.ResultsOut of 47 cases, 45 had successful operation. 187 parathyroid glands identified at the initial operation were reported in 47 patients. 43 patients had been diagnosed with parathyroid hyperplasia, and 4 patients had a benign adenoma. After operation, pruritus, bone pain and muscle weakness disappeared, also serum PTH and serum phosphate were declined markedly as well. After discharge, two patients (in total parathyroidectomy group) were readmitted because of postoperative hypoparathyroidism. Graft-dependent recurrence was not observed in an average follow-up of 42 months.ConclusionsTotal parathyroidectomy with sternocleidomastoid muscle trace amounts of parathyroid tissue autotransplantation is considered to be a feasible, safe and effective surgical option for the patients with sHPT.

Experience of surgical treatment of thyroid and parathyroid diseases

“…In 1 case (1.1 %), a tense mediastinal hematoma developed after sternotomy when an adenoma grown into the aortopulmonary window was removed, the complication was eliminated using a video-assisted mini-thoracotomy. The frequency of hemorrhagic complications in our study did not exceed the values reported by other authors -from 2 % to 4.3 % (bleeding, neck necrosis, requiring surgical drainage) [14,16].…”

Częściowe usunięcie przytarczyc versus całkowite usunięcie przytarczyc z autoprzeszczepem we wtórnej nadczynności przytarczyc — jednoośrodkowe, prospektywne badanie w grupie 43 pacjentów

“…As far as we know there is an ongoing randomised controlled trial (TOPAR PILOT-Trial), started in 2007, which aims to evaluate tPtx with or without thymectomy [9]. We did not routinely perform cervical thymectomy in our groups if four glands were confidently identified, an opinion also supported by others [18]. Furthermore, there are authors who consider the opportunity of a central compartment lymphadenectomy (CCL) in sHPT bearing in mind the frequency of supranumerary parathyroids in sHPT [3].…”

Efficacy and safety of ultrasound‐guided radiofrequency ablation of hyperplastic parathyroid gland for secondary hyperparathyroidism associated with chronic kidney disease

“…Because of the many nerves and other vital structures around the parathyroid glands, standard parathyroid gland surgery can be technically challenging and require a large incision. Because of resection inadequacy, parathyroidectomy often results in persistent and recurrent secondary HPT after surgery . On the other hand, excessive resection will lead to parathyroid gland dysfunction and increased difficulty of treating chronic kidney disease .…”

“…Refractory secondary HPT with intact parathyroid hormone (iPTH) levels >800 pg/mL in patients with chronic kidney disease is an indication for parathyroidectomy. This therapeutic approach can reduce the serum iPTH levels, improve the biochemical indexes, and effectively control patients' symptoms, but the surgical procedure is associated with possible complications because of the complexity of crucial anatomic structures, and with a high rate of postoperative persistent and recurrent secondary HPT . In addition, parathyroid hormone (PTH) is an essential physiological hormone, and it is difficult to precisely remove the adequate amount of hyperplastic parathyroid gland tissue without completely compromising the iPTH levels .…”