Outcomes of Subtotal Parathyroidectomy versus Total Parathyroidectomy with Autotransplantation for Tertiary Hyperparathyroidism

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Hye Ryeon Choi ◽  
Mohamed A. Aboueisha ◽  
Abdallah S. Attia ◽  
Mahmoud Omar ◽  
Ahmad ELnahla ◽  
...  
Keyword(s):  
Total Parathyroidectomy ◽  
Subtotal Parathyroidectomy ◽  
Tertiary Hyperparathyroidism

Total Parathyroidectomy versus Subtotal Parathyroidectomy in the Treatment of Tertiary Hyperparathyroidism

2012 ◽  
Vol 78 (5) ◽  
pp. 600-606 ◽  
Author(s):  
Ting-Min Hsieh ◽  
Cheuk-Kwan Sun ◽  
Yen-Ta Chen ◽  
Fong-Fu Chou
Keyword(s):  
Calcium Level ◽  
Total Parathyroidectomy ◽  
Long Term Outcomes ◽  
Subtotal Parathyroidectomy ◽  
Tertiary Hyperparathyroidism ◽  
Median Serum ◽  
Long Term Follow Up ◽  
Surgical Options

The purposes of this study are to evaluate the merits of surgical treatment, including subtotal parathyroidectomy (SP) and total parathyroidectomy (TP), in patients with tertiary hyperparathyroidism (THPT) and compare the outcome of the two surgical options. Medical records of patients undergoing parathyroidectomy for THPT were retrospectively reviewed and long-term outcomes between the two groups were compared. Fourteen out of 488 renal transplantation recipients required parathyroidectomy for THPT during a 24-year follow-up period with a median follow-up of 35.5 [interquartile range (IQR), 19.3–133.3] months. All patients had hypercalcemia, whereas 13 had varying symptoms and one was asymptomatic. Median serum calcium level decreased from 12.4 (IQR, 11.9–12.6) mg/dL preoperatively to 8.9 (IQR, 8.1–9.4) mg/dL postoperatively ( P = 0.001), whereas median intact parathyroid hormone (iPTH) dropped from a preoperative level of 340.5 (IQR, 247–540) pg/mL to 55.1 (IQR, 24.4–66.4) pg/mL after surgery ( P = 0.018). Comparison between patients receiving TP and SP revealed no difference in incidence of recurrence or permanent complications, whereas the former had significantly lower calcium levels ( P = 0.048) and higher phosphorus levels ( P = 0.017) compared with the latter. Moreover, a significant reduction in calcium level was noted in TP group on long-term follow-up compared with their immediately postoperative level (8.1 vs 9.0 mg/dL, respectively, P < 0.05), whereas there was no significant decrease in SP group. We concluded that parathyroidectomy is efficient and safe in treating THPT. Because TP would increase the risk of hypocalcemia, a less radical procedure (SP) is preferred.

scholarly journals Outcome of Total Parathyroidectomy and Autotransplantation as Treatment of Secondary and Tertiary Hyperparathyroidism in Children and Adults

2010 ◽  
Vol 34 (5) ◽  
pp. 993-1000 ◽  
Author(s):  
A. J. Kievit ◽  
J. G. M. Tinnemans ◽  
M. M. Idu ◽  
J. W. Groothoff ◽  
S. Surachno ◽  
...  
Keyword(s):  
Total Parathyroidectomy ◽  
Tertiary Hyperparathyroidism

scholarly journals SURGICAL ANATOMY OF PARATHYROID GLANDS IN PATIENTS WITH SECONDARY HYPERPARATHYROIDISM

2015 ◽  
Vol 7 (3) ◽  
pp. 23-28 ◽  
Author(s):  
K Yu Novokshonov ◽  
Y N Fedotov ◽  
V Y Karelin ◽  
T S Pridvizhkin ◽  
R A Chernikov ◽  
...  
Keyword(s):  
Secondary Hyperparathyroidism ◽  
Surgical Anatomy ◽  
Parathyroid Glands ◽  
Total Parathyroidectomy ◽  
Thyroid Lobe ◽  
Subtotal Parathyroidectomy ◽  
Carotid Sheath ◽  
Treat Ment ◽  
Gland Tissue ◽  
Surgical Failure

Ectopic or supernumerary parathyroid glands (PTg) can be the reason of surgical failure in treat- ment of secondary hyperparathyroidism in patients, who underwent dialysis. The aim of this study is to estimate the number and localization of PTgs in patients with secondary hyperparathyroidism. We included 165 patients, who underwent total parathyroidectomy with heterotopic autotransplantation of parathyroid gland tissue or subtotal parathyroidectomy. All identified PTgs were separated in two groups: eutopic and ectopic. Preoperative localization was performed by multispiral computed tomog- raphy of neck and mediastinum, neck ultrasonography, two-isotope Tc99 MIBI of PTgs. In postopera- tive period, we estimated the level of parathyroid hormone in the serum and performed morphological verification. There were found 659 PTgs. 12 (7,2%) patients had 3 parathyroid glands, and 11 (6.7%)had 5 PTgs. 4 Ptgs were found in 142 (86,1%) patients. 520 (78,9%) PTgs were eutopic, 139 (21,1%) - ectopic. The most common ectopic place for upper PTgs were paraesophageal and retrotracheal spaces, carotid sheath. Ectopic lower PTgs were most commonly located in the horns of the thymus. All super- numerary PTg were ectopic and often located in area between lower pole of the thyroid lobe and the thymus.Conclusion. During the operation in case when ectopy is suspected, upper PTgs should be located in in paraesophageal and paratracheal areas or in carotid sheath, if it necessary. If lower PTgs is absence, surgery should be completed cervical thymectomy.

scholarly journals Short- and long-term efficacy of total parathyroidectomy with immediate autografting compared with subtotal parathyroidectomy in hemodialysis patients.

1992 ◽  
Vol 3 (4) ◽  
pp. 1008-1017 ◽  
Author(s):  
E R Gagné ◽  
P Ureña ◽  
S Leite-Silva ◽  
J Zingraff ◽  
A Chevalier ◽  
...  
Keyword(s):  
Parathyroid Gland ◽  
Great Majority ◽  
Hemodialysis Patients ◽  
Chronic Hemodialysis ◽  
Total Parathyroidectomy ◽  
Short Term ◽  
Subtotal Parathyroidectomy ◽  
Surgical Methods ◽  
Long Term Follow Up

A retrospective study was performed in chronic hemodialysis patients comparing total parathyroidectomy (PTX) followed by immediate autografting (IA) (total PTX+IA) with subtotal parathyroidectomy (subtotal PTX). One hundred six patients with severe, uncontrolled hyperparathyroidism were referred to this center and underwent surgery during the period from 1980 to 1990. Long-term follow-up after PTX was available in 49 of them: 28 patients had total PTX+IA and 21 had subtotal PTX. The two surgical methods were evaluated with respect to preoperative severity of hyperparathyroidism, immediate postoperative results, and long-term parathyroid status, as evaluated by an RIA measuring intact immunoreactive parathyroid hormone (intact iPTH; normal values, 15 to 65 pg/mL). The initial degree of hyperparathyroidism was comparable in the two groups. An excellent short-term control of hyperparathyroidism was achieved in the great majority (95%) of patients with either surgical procedure. However, long-term normalization of parathyroid gland activity was achieved in only one third of patients whereas 33% had elevated intact iPTH levels (> 130 pg/mL; i.e., higher than twice the upper range of normal) and 32% had low intact iPTH levels (< 15 pg/mL), consistent with permanent hypoparathyroidism. No difference was found in the immediate failure rates: 0 of 28 cases after total PTX+IA compared with 2 of 21 cases after subtotal PTX. Similarly, long-term intact iPTH levels were comparable: 400 +/- 105 versus 212 +/- 82 pg/mL (mean +/- SE; P = not significant). Interestingly, long-term serum intact iPTH levels were higher in patients with nodular (N = 18) than with diffusely (N = 26) hyperplastic glands: 556 +/- 146 versus 126 +/- 52 pg/mL (P < 0.001) and recurrence of hyperparathyroidism was more frequent with nodular hyperplasia (11 of 18) than with diffuse hyperplasia (4 of 26) (P < 0.02). In conclusion, although excellent short-term results were obtained with both procedures, satisfactory long-term control of parathyroid gland function was achieved in only one third of the patients, the other two third remaining either hypoparathyroid or developing recurrent hyperparathyroidism. Last, the histological subtype of parathyroid glands was partially predictive of the recurrence of hyperparathyroidism.

Secondary Hyperparathyroidism

2019 ◽  
Author(s):  
Anna C Beck ◽  
Sonia L Sugg
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Secondary Hyperparathyroidism ◽  
Total Parathyroidectomy ◽  
Indications For Surgery ◽  
Subtotal Parathyroidectomy ◽  
Diagnostic Work ◽  
Work Up ◽  
Hungry Bone ◽  
Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references.  Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

Secondary Hyperparathyroidism

2019 ◽  
Author(s):  
Anna C Beck ◽  
Sonia L Sugg
Keyword(s):  
Renal Failure ◽  
Chronic Renal Failure ◽  
Secondary Hyperparathyroidism ◽  
Total Parathyroidectomy ◽  
Indications For Surgery ◽  
Subtotal Parathyroidectomy ◽  
Diagnostic Work ◽  
Work Up ◽  
Hungry Bone ◽  
Diagnostic Work Up

Secondary hyperparathyroidism is defined and its pathophysiology, delineated. Key components of the diagnostic work-up, medical management, and indications for surgery are described. The operative approach and controversy on extent of parathyroidectomy are discussed. This review contains 3 figures, 1 tables, and 24 references.  Key Words: autotransplantation, calciphylaxis, chronic renal failure, cryopreservation, hungry bone syndrome, hypocalcemia, secondary hyperparathyroidism, subtotal parathyroidectomy, total parathyroidectomy

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