A comparison of surgical treatments for tertiary hyperparathyroidism. A systematic review

Abstract

Introduction: Tertiary hyperparathyroidism develops in patients who have secondary hyperparathyroidism that persists despite successful kidney transplantation or in patients who are on chronic dialysis. Aim: This study aims to present a comparison of surgical treatments of tertiary hyperparathyroidism. Materials and methods: A systematic review of studies published in English that reported on the surgical management of tertiary hyperparathyroidism was conducted using PubMed databases in accordance with the PRISMA guidelines. Two authors independently reviewed the full text of potentially selectable articles and selected appropriate studies. Surgical treatment options were evaluated. Results: This review contains thirteen relevant studies. The treatments recommended by the studies included limited parathyroidectomy, subtotal parathyroidectomy, total parathyroidectomy with autotransplantation, and total parathyroidectomy without autotransplantation. The choice of the appropriate surgical technique demands individualization of the treatment and depends mainly on the experience of the surgeon. Conclusion: The predominant treatment options appear to be subtotal parathyroidectomy and total parathyroidectomy with autotransplantation.