Treatment for secondary hyperparathyroidism focusing on parathyroidectomy

Abstract

Secondary hyperparathyroidism (SHPT) is a major problem for patients with chronic kidney disease and can cause many complications, including osteodystrophy, fractures, and cardiovascular diseases. Treatment for SHPT has changed radically with the advent of calcimimetics; however, parathyroidectomy (PTx) remains one of the most important treatments. For successful PTx, removing all parathyroid glands (PTGs) without complications is essential to prevent persistent or recurrent SHPT. Preoperative imaging studies for the localization of PTGs, such as ultrasonography, computed tomography, and 99mTc-Sestamibi scintigraphy, and intraoperative evaluation methods to confirm the removal of all PTGs, including, intraoperative intact parathyroid hormone monitoring and frozen section diagnosis, are useful. Functional and anatomical preservation of the recurrent laryngeal nerves can be confirmed via intraoperative nerve monitoring. Total or subtotal PTx with or without transcervical thymectomy and autotransplantation can also be performed. Appropriate operative methods for PTx should be selected according to the patients’ need for kidney transplantation. In the case of persistent or recurrent SHPT after the initial PTx, localization of the causative PTGs with autotransplantation is challenging as causative PTGs can exist in the neck, mediastinum, or autotransplanted areas. Additionally, the efficacy and cost-effectiveness of calcimimetics and PTx are increasingly being discussed. In this review, medical and surgical treatments for SHPT are described.

Sagliker Syndrome in a Patient With Secondary Hyperparathyroidism and Chronic Kidney Disease: A Case Report From Palestine

“…The recurrent SHPT may arise from the neck, mediastinum, or autografted forearm. The causative parathyroid glands could be localized using imaging modalities such as US, CT, MIBI scintigraphy, or magnetic resonance imaging (MRI) [ 16 ]. Reversal of severe skeletal deformities is impossible, while better control of SHPT may stop its progression and provide a better quality of life [ 8 ].…”

Recurrent laryngeal never monitoring versus non-monitoring in parathyroid surgery

“…Currently, ultrasonography (US), computed tomography (CT), and single-photon emission computed tomography (SPECT)-CT with sestamibi Tc99m can achieve 100% accuracy in the preoperative localization of parathyroid glands ( 2 , 30 ). Therefore intraoperative exploration of parathyroid glands that are not localized is common.…”

“…Parathyroidectomy (PTX) is an effective treatment for drug-refractory primary hyperparathyroidism (PHPT) and secondary hyperparathyroidism (SHPT) ( 1 , 2 ). PHPT and SHPT have a high prevalence in China, and the incidence of PHPT and SHPT is increasing every year ( 3 , 4 ).…”

Advantages of total parathyroidectomy in patients with secondary hyperparathyroidism induced by end stage renal disease

“…numerous discussions on the surgical technique adopted. This is due to the increased postoperative morbidity and the recurrence of the disease (19,20). On the other hand studies have begun to appear that demonstrates that total parathyroidectomy, in addition to decreasing the risk of recurrence, also decreases mortality due to vascular or other causes.…”