Outcome of Parathyroidectomy for Renal Hyperparathyroidism : a Single-Center Experience


  • Kreangsak Chainapapong Department of Surgery, Chonburi Hospital, Chonburi


Renal hyperparathyroidism, Total parathyroidectomy, Autotransplantation


Objective: To evaluate and compare early and long-term outcomes and of total (TPTX) and partial parathyroidectomy (PPTX) operations in the management of patients with resistant renal hyperparathyroidism (rHPT) at Chonburi Hospital, Thailand.

Methods: A single center retrospective medical record review of parathyroidectomy, with or without autotransplantation (AT), from 1 January 2012 to 31 March 2021 was performed. 

Results: A total of 110 patients were operated on for rHPT during the study period. The preoperative parathyroid hormone (PTH) levels were markedly high in both groups. Preoperative parathyroid localization was performed in less than 50% of cases. Eighty-four received TPTX, with or without AT, and 26 received PPTX. The average post-operative PTH levels at 24 hours, at 1, 3, 6 and 12 months after operation in TPTX group were significant lower compared with those of the PPTX group. Postoperative blood calcium levels (48 hours after operation) were found to be very low in both groups. Postoperative phosphate level (48 hours after operation) in the TPTX group returned to normal, while it remained elevated in PPTX group. Overall complications of either operation were very low. Eight patients in the PPTX group required reoperation for persistent hyperparathyroidism resistant to non-operative treatment. Five patients had successful primary operations. The remaining 18 PPTX cases continued medical treatment. Sixty patients received TPTX without AT and 24 patients received TPTX with AT. The blood PTH levels of those who had TPTX with AT tended to be higher than that of those who had TPTX without AT at 1, 3, 6 and 12 months after operation, but without statistical significance. Five of 24 patients (20%) who had TPTX with AT experienced recurrent HPT, while none of those who had TPTX without AT did. Two patients with recurrent HPT received autografectomy. Persistent hypoparathyroidism (PTH < 10 pg/mL) was found 10 patients (16%) who had TPTX without AT, but did not occur in any case of TPTX with AT, with a follow up of more than 12 months.

Conclusion: Total parathyroidectomy with or without autotransplantation is the operation of choice for rHPT.  The experience of the surgeon is the most important factor for operative success.


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Zhan Y, Lu Y, Feng S, et al. Evaluation of laboratory parameter and symptoms after parathyroidectomy in dialysis patients with secondary hyperparathyroidism. Ren Fail 2019;41:921-9.

Brunicardi FC, Brandt ML, Anderson DK, et al. Schwartz’s principles of surgery. 10th ed. New York: McGraw-Hill, 2010:1537-1538.

Madorin C, Owen RP, Fraser WD, et al. The surgical management of renal hyperparathyroidism. Eur Arch Otorhionolaryngol 2012;269:1565-76.

Schneider R, Bartsch DK. Role of surgery in the treatment of renal secondary hyperparathyroidism. Br J Surg 2015;102:289-90.

Tominaga Y, Matsuoka S, Uno N, et al. Parathyroidectomy for secondary hyperparathyroidism in the era of calcimimetics. Ther Apher Dial 2008;12:21–26.

Bartsch DK, Sancho JJ, Guigard S, et al. Surgical management of secondary hyperparathyroidism in chronic kidney disease—a consensus report of the European Society of Endocrine Surgeons. Langenbecks Arch Surg 2015;400:907-27.

Cohen EP, Moulder JE. Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery? Nephron 2001;89:271-3.

Kidney disease: Improving Global Outcomes (KDIGO) CKD-MBD Work Group. KDIGO clinical practice guideline for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder (CKD-MBD) Kidney Int Suppl 2009;113:S1-130. doi:10.1038/ki.2009.188.

Chow TL, Chan TT, Ho YW, et al. Improvement of anemia after parathyroidectomy in Chinese patients with renal failure undergoing long-term dialysis. Arch Surg 2007;142:644-8.

Jones BA, Lindeman B, Chen H. Are Tc-99m-sestamibi scans in patients with secondary hyperparathyroidism and renal failure needed? J Surg Res 2019 243:380-3.

Hiramitsu T, Tomosugi T, Okada M, et al. Pre-operative localisation of the parathyroid glands in secondary hyperparathyroidism: a retrospective cohort study. Sci Rep 2019;9:14634. https://doi.org/10.1038/s41598-019-51265-y.

Lee B, Kim YW, Lee YM. The role of preoperative ultrasonography, computed tomography, and sestamibi scintigraphy localization in secondary hyperparathyroidism. Ann Surg Treat Res 2015;89:300-5.

Alkhalili E, Tasci Y, Aksoy E, et al. The utility of neck ultrasound and sestamibi scans in patients with secondary and tertiary hyperparathyroidism. World J Surg 2015;39:701-5.

Lai E, Ching AS, Leong HT. Secondary and tertiary hyperparathyroidism: role of preoperative localization. ANZ J Surg 2007;77:880-2.

Schneider R, Bartsch DK. Role of surgery in the treatment of renal secondary hyperparathyroidism. Br J Surg 2015;102:289-90.

Rothmund M, Wagner PK, Schark C. Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 1991;15:745-750.

Ketteler M, Block G, Evenepoel P, et al. Diagnosis, evaluation, prevention, and treatment of chronic kidney disease-mineral and bone disorder: synopsis of the kidney disease: Improving Global Outcomes 2017 Clinical Practice Guideline Update. Ann Intern Med 2018;168:422-30.

Casella C, Galani A, Totaro L. Total parathyroidectomy with subcutaneous parathyroid forearm autotransplantation in the treatment of secondary hyperparathyroidism: A single-center experience. Int J Endocrinol 2018. https://dx.doi.org/10.1155%2F2018%2F6065720.

Pattou FN, Pellissier LC, Noel C, et al. Supernumerary parathyroid glands: frequency and surgical significance in treatment of renal hyperparathyroidism. World J Surg 2000;24:1330-4.

Burgstaller T, Selberherr A, Brammen L, et al. How radical is total parathyroidectomye in patients with renal hyperparathyroidism? Langerbecks Arch Surg 2018;403:1007-13.




How to Cite

Chainapapong K. Outcome of Parathyroidectomy for Renal Hyperparathyroidism : a Single-Center Experience. Thai J Surg [Internet]. 2022 May 5 [cited 2022 Dec. 9];43(1):18-25. Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/251475



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