Background
Our aim was to examine the outcomes of patients with tertiary hyperparathyroidism
(3-HPT) who had limited resection of 1 or 2 parathyroids.
Methods
We reviewed 140 patients with 3-HPT who underwent parathyroidectomy (PTX) at a single
institution. Patients were analyzed according to their operation—limited PTX versus
subtotal or total PTX.
Results
The limited PTX group consisted of 29 patients who underwent resection of 1 (n = 12) or 2 (n = 17) parathyroids. The other 111 patients had subtotal (n = 104), total (n = 3), and/or reoperative PTX (n = 12). The mean ± SEM follow-up was 79 ± 5 months. Eucalcemia was achieved in 94%
of the patients. All patients with persistent (n = 2) hypercalcemia underwent subtotal PTX (P = not significant [NS] vs limited PTX). In a logistic regression model, the extent
of operation was not associated with the development of recurrent disease. Additionally,
the incidence of permanent hypocalcemia was 7% after subtotal or total PTX versus
0% after limited resection (P = NS).
Conclusion
Long-term outcomes in patients with 3-HPT appear to be similar after appropriate limited
resection of 1 or 2 parathyroid glands compared to subtotal or total PTX. Therefore,
a strategy of limited parathyroid resection seems appropriate for patients with 3-HPT
when the disease is limited to 1 or 2 glands.
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References
- Operative treatment of tertiary hyperparathyroidism: a single-center experience.Ann Surg. 1998; 227: 878-886
- Tertiary hyperparathyroidism after renal transplantation: surgical strategy.Surgery. 1998; 124 (discussion 83-4): 677-683
- Tertiary hyperparathyroidism after renal transplantation: operative indications.Surgery. 1989; 106 (discussion 55-6): 1049-1055
- Tertiary hyperparathyroidism after renal transplantation.Pediatr Nephrol. 1997; 11: 65-68
- Clinical and operative management of persistent hyperparathyroidism after renal transplantation: a single-center experience.Head Neck. 2007; 29: 996-1001
- Long-term follow-up of patients with tertiary hyperparathyroidism treated by resection of a single or double adenoma.Ann Surg. 2002; 235 (discussion 8-80): 673-678
- Tertiary hyperparathyroidism: histologic patterns of disease and results of parathyroidectomy.Arch Surg. 2004; 139: 974-977
- Subtotal parathyroidectomy with thymectomy for autonomous hyperparathyroidism after renal transplantation.Br J Surg. 2005 Oct; 92: 1282-1287
- Less-than-subtotal parathyroidectomy increases the risk of persistent/recurrent hyperparathyroidism after parathyroidectomy in tertiary hyperparathyroidism after renal transplantation.Surgery. 2006; 140 (discussion 7-9): 990-997
- Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism.Surgery. 2003; 134 (discussion 7-9): 713-717
- The role of intraoperative parathyroid hormone testing in patients with tertiary hyperparathyroidism after renal transplantation.Surgery. 2005; 138 (discussion 71): 1066-1071
- Prediction of creatinine clearance from serum creatinine.Nephron. 1976; 16: 31-41
- Expressing the Modification of Diet in Renal Disease study equation for estimating glomerular filtration rate with standardized serum creatinine values.Clin Chem. 2007; 53: 766-772
- K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease.Am J Kidney Dis. 2003; 42: S1-201
- Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies.Ann Surg. 2001; 233: 65-69
- Near-total parathyroidectomy is beneficial for patients with secondary and tertiary hyperparathyroidism.Surgery. 2004; 136: 1252-1260
- Mycophenolate mofetil versus azathioprine therapy is associated with a significant protection against long-term renal allograft function deterioration.Transplantation. 2003; 75: 1341-1346
Article info
Publication history
Accepted:
September 24,
2009
Footnotes
Presented at the 30th Annual Meeting of the American Association of Endocrine Surgeons, Madison, Wisconsin, May 2–5, 2009.
Supported in part by research grants from the American College of Surgeons Resident Research Scholarship and the National Institutes of Health (grant T32 CA009614-19 Physician Scientist Training in Cancer Medicine).
Identification
Copyright
© 2009 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
