Clinical Characteristics of ESRD Patients with Severe Hyperparathyroidism Who Undertook Surgical Parathyroidectomy

Han, Seung Hyeok; Lee, Sang Cheol; Kang, E Hwa; Goo, Young Suk; Park, Hyung Chun; Roh, Hyun Jeong; Noh, Hyun Jin; Yoon, Soo Young; Yun, Do Sik; Choi, So Rye; Kang, Shin Wook; Choi, Kyu Hun; Lee, Ho Yung; Han, Dae Suk; Seo, Jin Hak; Jeong, Wung Yoon; Park, Jeong Soo

Abstract

BACKGROUND: Medical treatments such as restriction of phosphate, phosphate binder use, and active vitamine D therapy have been widely used for hyperparathyroidism in ESRD patients, and surgical parathyroidectomy should be considered in patients with uncontrolled hyperparathyroidism.
METHODS
A retrospective study was performed in 24 ESRD patients with severe and uncontrolled hyperparathyroidism despite of medical treatment who undertook surgical parathyroidectomy in Severance hospital from 1990 to 1999.
RESULTS
Sixteen patients had total parathyroidectomy with immediate autotransplant, 7 patients had subtotal parathyroidectomy and only 1 patient had minimally invasive parathyroidectomy. An excellent short-term control of hyperparathyroidism was achieved in all patients after parathyroidectomy. Preoperative bone and joint pain improved in 16 of 19 patients. Muscle weakness and pain improved in 11 of 17 patiens, malaise improved in 8 of 10 patients and pruritus improved in 10 of 13 patients. In addition, clinical laboratory finding improved after parathyroidectomy. No clinical differences were seen between 16 patients who undertook total parathyroidectomy with immediate autotransplant and 7 patients who undertook subtotal parathyroidectomy. Recurrence of hyperparathyroidism ocurred in 5 of 24 patients with 4 nodular hyperplasia and 1 diffuse hyperplasia in pathologic finding. The less degree of attenuated response of intact PTH levels immediately after operation was observed in 5 recurrent cases.
CONCLUSION
Good results were obtained after parathyroidectomy. We believe that histologic subtype and the attenuated response of intact PTH after surgical parathyroidectomy could be possible predictors of the recurrent hyperparathyroidism.