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

Qingqing He,Songjian Duan,Ziyi Fan,Peng Zhou,Jian Zhu,Yanning Li,Zhen Lv,Dayong Zhuang,Yanming Ge,Lei Cao,Luming Zheng

doi:10.1186/1471-2482-14-26

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.

Highlights

The aim of the study was to evaluate total parathyroidectomy with trace amounts of parathyroid tissue (30 mg) as a surgical option in secondary hyperparathyroidism treatment
The aim of this study is to examine our experience with patients who underwent total parathyroidectomy with or without trace amounts of parathyroid tissue autotransplantation for secondary hyperparathyroidism (sHPT)
Patient eligibility and study design We performed a retrospective study of 47 patients with chronic renal failure, who experienced total parathyroidectomy with or without sternocleidomastoid muscle autografting for sHPT from January 2008 to March 2012

Summary

Introduction

The 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. SHPT is ubiquitous in patients with chronic kidney failure treated by long-term dialysis. High parathyroid hormone (PTH) levels can lead to 1) renal osteodystrophy, 2) calciphylaxis, 3) ectopic calcifications, 4) abnormal fat and sugar metabolism, 5) refractory pruritis, and 6) anemia [1,2,3]. New treatments for sHPT include vitamin D analogues and calcimimetics. When vitamin D analogues and calcimimetics fails, parathyroidectomy becomes necessary. Surgical treatment of sHPT may involve various surgical approaches [3,4,5,6]. Surgical options for the treatment of sHPT include

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