Comparison of Operative Methods for Tertiary Hyperparathyroidism

Kim, Hee Jeong; Kim, Yon Seon; Hong, Suk Joon

Abstract

PURPOSE: Tertiary hyperparathyroidism (THPT) occurs in less than 8% of the patients with secondary hyperparathyroidism after successful kidney transplantation. Tertiary hyperparathyroidism is commonly due to parathyroid hyperplasia, but about 2.6% of the THPT cases may be due to single or double adenomas. We investigate the usefulness of limited resection of single or two-gland parathyroid by comparing the blood calcium and PTH levels with respect to operative strategy.
METHODS
We analyzed a total of 13 cases of tertiary hyperparathyroidism that were diagnosed and operated on at Asan Medical Center from May 1996 to April 2005. The patients were grouped according to the operative strategy: 3 and 1/2-parathyroidectomy (n=5), 3-parathyroidectomy (n=6), and 2-parathyroidectomy (n=2), and then we compared the mean blood PTH, calcium and creatinine levels. One patient in the 3-parathyroidectomy group underwent hemodialysis due to kidney transplant rejection, and this data was excluded from the analysis.
RESULTS
The mean blood calcium and PTH levels of the 2-parathyroidectomy group were higher than that of the other two groups. There were no cases of transient hypocalcemia in the 3 groups (<7.5 mg/dl), and there were no cases of hypercalcemia at one year postoperative in the 3 & 1/2-parathyroidectomy and 2-parathyroidectomy groups. The blood calcium and blood PTH levels were less than 9.1 mg/dl and more than 100 pg/ml, respectively, in the one 3-parathyroidectomy patient who underwent hemodialysis due to kidney transplant rejection.
CONCLUSION
Our preliminary conclusions, based on our small groups and the short follow-up period, are that the blood calcium and PTH levels will be higher in the limited resection group if kidney transplant rejection occurs, and tumor recurrence will be also more often found in the limited resection group. Therefore, our recommendation is that 3 and 1/2-parathyroidectomy and 2-parathyroidectomy are preferable operative strategies for tertiary hyperparathyroidism.