Outcome of Parathyroidectomy for Renal Hyperparathyroidism : a Single-Center Experience
Keywords:
Renal hyperparathyroidism, Total parathyroidectomy, AutotransplantationAbstract
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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