Strategy for the treatment of secondary hyperparathyroidism

Abstract

Secondary hyperparathyroidism (SHPT) has become one of the most common complications of chronic kidney disease (CKD), and seriously affects the patients′ quality of life, whose treatment strategy consists of medication, surgery, and intervention. Its medications include non-selective and selective active vitamin D and cinacalcet, during which the changes of serum intact parathyroid hormone (iPTH), calcium, and phosphorus are monitored, so that the doses of drugs can be timely adjusted. When medical treatment is ineffective and the patient has the indication for surgery, parathyroidectomy (PTX) or ultrasound interventional therapy can be considered. High frequency color ultrasound and/or 99Tcm-MIBI dual-phase scintigraphy are/is required for the preoperative localization diagnosis of parathyroid. There are three parathyroidectomy methods, among which total parathyroidectomy plus autotransplantation is currently the most-used surgical method. Color ultrasound-guided thermal ablation of parathyroid gland may be used as a new treatment strategy for patients who can′t tolerate PTX or requires a second PTX. Key words: Secondary hyperparathyroidism; Active vitamin D; Cinacalcet; Parathyroidectomy; Ablation technology