Experience of surgical treatment of secondary hyperparathyroidism

Abstract

Surgical treatment of secondary hyperparathyroidism (HPT) in patients having renal replacement therapy (RRT) is a current problem. The aim of our study was to optimize the treatment of secondary HPT based on the comparative analysis of effectiveness of the surgeries with different extents. We conducted a retrospective analysis of the results of surgical treatment of uremic HPT in 34 patients. 36 surgeries were performed including 34 primary (16 subtotal parathyroidecomies (PTE), 13 total parathyroidecomies (total PTE 1), 5 total parathyroidecomies with central neck dissection and resection of superior mediastinum and superior thymus horns (total PTE II)) and 2 repeated surgeries (total PTE 11 and parathyroidadenomectomy). Gross examination of 134 surgical specimens revealed dyssynchronous pathological changes in parathyroid glands (PTG), normal PTG structure was found in 2 cases. Recurrent HPT was found in 3 cases, persistent HPT - in 9 cases, hypoparathyroidism - in 5 cases after subtotal PTE and in 9 cases after total PTE with autotransplantation (p = 0,267). Target values of parathyroid hormone were registered in 8 patients, including 4 patients after subtotal PTE and 4 patients after total PTE (p > 0,95). Morbidity was similar in all types of surgeries (p > 0,5). Analysis of morbidity determined that simultaneous surgery of thyroid gland increased the risk of laryngeal paralysis (р = 0,028). The decrease in occurrence of secondary HPT persistence (with the source accessible for removal through cervical approach) at total PTE based on the removal of parathyroid glands of all localizations accessible through cervical approach (including thyroid gland lobes with diagnosed ectopia, central cervical fat pad, superior mediastinum and superior thymus horns) was registered (NNT = 4).

Keywords

• secondary hyperparathyroidism
• parathyroidectomy