Background
Secondary hyperparathyroidism is a common clinical problem seen in patients with end-stage
renal disease (ESRD) undergoing hemodialysis. In patients with severe persistent hyperparathyroidism,
parathyroidectomies are often required.
Objectives
We sought to evaluate the feasibility and efficacy of total parathyroidectomy followed
by subcutaneous injection of parathyroid autograft compared with surgical implantation.
Methods
We conducted a retrospective study of 132 patients with confirmed diagnoses of ESRD
treated with hemodialysis or peritoneal dialysis, with secondary hyperparathyroidism
who had undergone total parathyroidectomies. Clinical and biochemical characteristics,
including preoperative and postoperative intact parathyroid hormone levels were recorded
and compared between patients who had undergone subcutaneous injection or surgical
implantation of autograft.
Results
From February 2005 to February 2012, 132 patients who had undergone total parathyroidectomies
were included in our study. To compare the techniques of subcutaneous injection and
surgical implantation, pre- and postoperative biochemistry was recorded and analyzed.
Preoperative biochemistry was comparable in both groups. However, autograft recovery
was significantly faster in the group with subcutaneous injection compared with surgical
implantation (P = .03). Median time to parathyroid recovery was 2 months for injection compared with
9 months for implantation. There was no remarkable difference in the recurrence rates
between the 2 groups.
Conclusion
Subcutaneous injection of parathyroid tissue is a feasible and simple alternative
to the more commonly used method of surgical implantation.
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Article info
Publication history
Published online: December 26, 2013
Accepted:
December 18,
2013
Footnotes
W.W., M.-J.C., and M.-S.T. contributed equally to the manuscript.
Identification
Copyright
© 2014 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
