Int J Thyroidol.  2019 Nov;12(2):132-136. 10.11106/ijt.2019.12.2.132.

Subtotal Parathyroidectomy for Tertiary Hyperparathyroidism: a Case Report and Literature Review

• Jang Y
• Kim GH
• Park JH
• Tae K

• KMID: 2465067
• DOI: http://doi.org/10.11106/ijt.2019.12.2.132

Abstract

Despite the correction of secondary renal hyperparathyroidism after successful kidney transplantation, some recipients have persistent hyperparathyroidism due to autonomous hypertrophied parathyroid glands. St. Goar first identified and termed this disease as tertiary hyperparathyroidism. Surgery, either subtotal parathyroidectomy or total parathyroidectomy with autotransplantation, is the main treatment for tertiary hyperparathyroidism. Here, we report a case of a patient with tertiary hyperparathyroidism after two times of kidney transplantation who underwent subtotal parathyroidectomy and also review the relevant literature.

Keyword

Hyperparathyroidism; Kidney transplantation; Parathyroidectomy

MeSH Terms

Autografts
Humans
Hyperparathyroidism*
Kidney Transplantation
Parathyroid Glands
Parathyroidectomy*
Transplantation, Autologous

Figure

• 

  Fig. 1 Preoperative imaging studies. (A) Ultrasonography showing two cystic lesions in the right and left superior parathyroid glands. (B) Computed tomography scan showing three hyperplastic parathyroid glands at the right superior (solid line arrows), left superior (dash line arrows), and left inferior parathyroid glands. (C) Tc-99m methoxy iso butyl isonitrile (MIBI) parathyroid scan showing increased uptake in four parathyroid glands (solid line arrows indicates right superior parathyroid gland, right inferior parathyroid gland, left superior parathyroid gland, and left inferior parathyroid gland, in the order of the figures).

• 

  Fig. 2 Operative views of subtotal parathyroidectomy. (A) The right superior (solid line arrow) and right inferior parathyroid glands (dashed line arrow) are shown. (B) The left superior (solid line arrow) and left inferior parathyroid gland (dashed line arrow) are shown. (C) The right superior parathyroid gland (solid line arrow) and 1/2 of right inferior parathyroid gland were removed with preservation of half of the right inferior parathyroid gland in situ (dashed line arrow). (D) The left superior (solid line arrow) and left inferior parathyroid gland (dashed line arrow) are removed. (E) Surgical specimen of the parathyroid glands.

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