Total parathyroidectomy in patients with chronic renal failure

Abstract

Abstract Background Total parathyroidectomy without reimplantation has been advocated as a treatment for hyperparathyroidism in patients with end-stage chronic renal failure. However, there are concerns that a lack of endogenous parathyroid hormone (PTH) can result in hypocalcaemia and adynamic bone disease. The aim of this study was to identify whether this is a significant clinical problem. Methods A review of 56 (51 four-gland and five three-gland) histologically confirmed parathyroidectomies performed by the same surgeon between 1994 and 1999 was performed. Mean(s.d.) follow-up was 30(22) months. Results Patients could be divided into three groups on the basis of a postoperative serum PTH concentration that was either undetectable (less than 0·1 pmol l−1), less than the upper limit of normal (7·6 pmol l−1 or less) or raised (more than 7·6 pmol l−1). Demographics, mean number of glands excised and histology were similar in each group. Patients with a raised serum level of PTH had a mean(s.d.) value of 54·1(73·3) pmol l−1. Three-gland parathyroidectomy occurred in three patients, raising the possibility of ectopic glands. Two patients had neck re-exploration after four-gland parathyroidectomy; an adenoma and an ectopic gland were identified. One patient had a parathyroid adenocarcinoma. Conclusion Total parathyroidectomy may leave residual functional parathyroid tissue that is not visualized at surgery. However, in patients who had no functional parathyroid tissue after operation there was little clinical or biochemical evidence of an increased incidence of hypocalcaemia or bone disease.