Surgical treatment for refractory secondary hyperparathyroidism in chronic kidney disease patients after dialysis: a case series report series of 120 cases

Abstract

Objective To summarize the clinical features and the outcome of surgical treatment of refractory secondary hyperparathyroidism (SHPT) after dialysis in patients with chronic kidney disease (CKD). Methods A study was conducted on 102 CKD patients with refractory SHPT after dialysis who received surgical treatment in our hospital from January 2018 to December 2019. The clinical characteristics including hematological indicators were analyzed. The treatment outcome and postoperative complications were summarized. Results The decrement of parathyroid hormone (PTH) level on postoperative day 1 was higher than 80% of preoperative PTH level. On postoperative day 1 and day 7 and month 3, the serum levels of calcium, phosphorus and PTH were significantly decreased when compared with the preoperative values. There were 4 cases having thyroidectomy, 20 cases experincing central lymph node dissection, and 10 cases undergoing thymus resection. During the perioperative period, 15 patients had numbness on hands, feet and perioral area, and 2 of them had distal upper extremity convulsion. The systemic symptoms were greatly relieved in 99 patients within 1 week after surgery. There were 5 cases of permanent hypoparathyroidism and 2 cases of recurrent SHPT after operation. Conclusion Surgery is the most effective treatment for refractory SHPT. Multiple imaging examinations should be used to locate parathyroid gland, and detailed evaluation should be conducted preoperatively. During postoperative period, hematological indicators should be closely monitored and timely treatment of complications is necessary.

Keywords

• chronic kidney disease
• refractory secondary hyperparathyroidism
• surgical treatment outcome
• total parathyroidectomy