Clin Exp Otorhinolaryngol.  2020 May;13(2):173-178. 10.21053/ceo.2019.01340.

Surgical Outcomes of Subtotal Parathyroidectomy for Renal Hyperparathyroidism

• Kim MS
• Kim GH
• Lee CH
• Park JS
• Lee JY
• Tae K

• KMID: 2500290
• DOI: http://doi.org/10.21053/ceo.2019.01340

Abstract

Objectives
. The aim of this study was to evaluate the effectiveness of subtotal parathyroidectomy for patients with renal hyperparathyroidism.
Methods
. We studied 25 patients with renal hyperparathyroidism who underwent subtotal parathyroidectomy from October 2002 to October 2017. We analyzed serum intact parathyroid hormone (iPTH), calcium, and inorganic phosphorus levels before and at multiple time points following surgery, and evaluated the surgical outcomes and complications.
Results
. Of the 25 patients, 13 (52%) were male and 12 (48%) were female, and the mean age was 53.4±9.3 years. The mean duration of dialysis before parathyroidectomy was 156.8±79.5 months. Mean preoperative serum iPTH and calcium levels were 1,199.0±571.3 pg/mL and 10.5±1.0 mg/dL, respectively. At 6 months postoperatively, the mean iPTH and calcium levels decreased to 49.2±47.6 pg/mL (P<0.01) and 8.0±1.0 mg/dL (P<0.01), respectively. Recurrent hyperparathyroidism occurred in two patients: one subsequently underwent kidney transplantation and the other continued hemodialysis and maintained normal calcium levels. One patient developed postoperative permanent hypoparathyroidism.
Conclusion
. Subtotal parathyroidectomy is a safe and effective surgical treatment for renal hyperparathyroidism.

Keyword

Secondary Hyperparathyroidism; Chronic Renal Insufficiency; Parathyroidectomy

Figure

• 

  Fig. 1. The surgical procedures of subtotal parathyroidectomy. (A) Identification of the bilateral four parathyroid glands before the resection (white arrows). (B) Surgical view after subtotal parathyroidectomy, in which a small part of the left inferior parathyroid gland has been left in situ (black arrow). (C) Surgical specimen from subtotal parathyroidectomy.

• 

  Fig. 2. Changes in serum intact parathyroid hormone (iPTH) level before and after subtotal parathyroidectomy. Dashed lines indicate patients with recurrent hyperparathyroidism, and the dash-dotted line indicates one patient with permanent hypoparathyroidism. The solid black line indicates the reference value for recurrent hyperparathyroidism (195 pg/mL). Pre, preoperative; Post, postoperative.

• 

  Fig. 3. Changes in serum calcium level before and after subtotal parathyroidectomy. Dashed lines indicate patients with postoperative hypocalcemia. The solid black line indicates the reference value for postoperative hypocalcemia. Pre, preoperative; Post, postoperative.

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