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Tertiary hyperparathyroidism: Is less than a subtotal resection ever appropriate? A study of long-term outcomes

      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

        • Kerby J.
        • Rue L.
        • Blair H.
        • Hudson S.
        • Sellers M.
        • Diethelm A.
        Operative treatment of tertiary hyperparathyroidism: a single-center experience.
        Ann Surg. 1998; 227: 878-886
        • Kilgo M.
        • Pirsch J.
        • Warner T.
        • Starling J.
        Tertiary hyperparathyroidism after renal transplantation: surgical strategy.
        Surgery. 1998; 124 (discussion 83-4): 677-683
        • D'Alessandro A.M.
        • Melzer J.S.
        • Pirsch J.D.
        • Sollinger H.W.
        • Kalayoglu M.
        • Vernon W.B.
        • et al.
        Tertiary hyperparathyroidism after renal transplantation: operative indications.
        Surgery. 1989; 106 (discussion 55-6): 1049-1055
        • Nieto J.
        • Ruiz-Cuevas P.
        • Escuder A.
        • Regas J.
        • Callis L.
        Tertiary hyperparathyroidism after renal transplantation.
        Pediatr Nephrol. 1997; 11: 65-68
        • Gilat H.
        • Feinmesser R.
        • Vinkler Y.
        • Morgenstern S.
        • Shvero J.
        • Bachar G.
        • et al.
        Clinical and operative management of persistent hyperparathyroidism after renal transplantation: a single-center experience.
        Head Neck. 2007; 29: 996-1001
        • Nichol P.
        • Starling J.
        • Mack E.
        • Klovning J.
        • Becker B.
        • Chen H.
        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
        • Kebebew E.
        • Duh Q.
        • Clark O.
        Tertiary hyperparathyroidism: histologic patterns of disease and results of parathyroidectomy.
        Arch Surg. 2004; 139: 974-977
        • Triponez F.
        • Dosseh D.
        • Hazzan M.
        • Noel C.
        • Vanhille P.
        • Proye C.
        Subtotal parathyroidectomy with thymectomy for autonomous hyperparathyroidism after renal transplantation.
        Br J Surg. 2005 Oct; 92: 1282-1287
        • Triponez F.
        • Kebebew E.
        • Dosseh D.
        • Duh Q.
        • Hazzan M.
        • Noel C.
        • et al.
        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
        • Nichol P.
        • Mack E.
        • Bianco J.
        • Hayman A.
        • Starling J.
        • Chen H.
        Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism.
        Surgery. 2003; 134 (discussion 7-9): 713-717
        • Haustein S.
        • Mack E.
        • Starling J.
        • Chen H.
        The role of intraoperative parathyroid hormone testing in patients with tertiary hyperparathyroidism after renal transplantation.
        Surgery. 2005; 138 (discussion 71): 1066-1071
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Levey A.S.
        • Coresh J.
        • Greene T.
        • Marsh J.
        • Stevens L.A.
        • Kusek J.W.
        • et al.
        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
        • National Kidney Foundation
        K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease.
        Am J Kidney Dis. 2003; 42: S1-201
        • Gasparri G.
        • Camandona M.
        • Abbona G.
        • Papotti M.
        • Jeantet A.
        • Radice E.
        • et al.
        Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies.
        Ann Surg. 2001; 233: 65-69
        • Milas M.
        • Weber C.
        Near-total parathyroidectomy is beneficial for patients with secondary and tertiary hyperparathyroidism.
        Surgery. 2004; 136: 1252-1260
        • Meier-Kriesche H.
        • Steffen B.
        • Hochberg A.
        • Gordon R.
        • Liebman M.
        • Morris J.
        • et al.
        Mycophenolate mofetil versus azathioprine therapy is associated with a significant protection against long-term renal allograft function deterioration.
        Transplantation. 2003; 75: 1341-1346