Surgical treatment of secondary hyperparathyroidism

Abstract

Secondary hyperparathyroidism is one of the most serious complications for long-term hemodialysis patients. In our department, we performed parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomies on 215 patients between July 1973 and June 1990. We found that parathyroidectomy was an effective treatment for advanced renal hyperparathyroidism and that after total parathyroidectomy with forearm autograft, renal hyperparathyroidism was controllable, even when hyperparathyroidism was progressive. However, the timing of this operation was important, because skeletal deformity and vessel calcification did not improve after parathyroidectomy. There were two problems after parathyroidectomy for secondary hyperparathyroidism. One was persistent hyperparathyroidism due to supernumerary parathyroid glands, particularly those located in the mediastinum, and the other was recurrent hyperparathyroidism. From our clinical and pathohistological investigations, we suspected that the proliferation of parathyroid cells changed with the progress of renal hyperparathyroidism and we found that it was difficult to prevent enlargement of parathyroid glands and recurrence of this problem.