Original Communication| Volume 155, ISSUE 4, P682-688, April 2014

Subcutaneous injection is a simple and reproducible option to restore parathyroid function after total parathyroidectomy in patients with secondary hyperparathyroidism

Published:December 26, 2013DOI:


      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.


      We sought to evaluate the feasibility and efficacy of total parathyroidectomy followed by subcutaneous injection of parathyroid autograft compared with surgical implantation.


      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.


      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.


      Subcutaneous injection of parathyroid tissue is a feasible and simple alternative to the more commonly used method of surgical implantation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Surgery
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Tominaga Y.
        • Numano M.
        • Tanaka Y.
        • Uchida K.
        • Takagi H.
        Surgical treatment of renal hyperparathyroidism.
        Semin Surg Oncol. 1997; 13: 87-96
        • Vathsala A.
        Twenty-five facts about kidney disease in Singapore: In remembrance of world kidney day.
        Ann Acad Med Singapore. 2007; 36: 157-160
      1. Trends of end stage renal disease in Singapore. Singapore. National Registry of Diseases Office, Singapore2013
      2. Lin C.H. Eighth report of the Singapore Renal Registry 2009. Singapore. National Registry of Diseases Office, Singapore2012
        • Riss P.
        • Asari R.
        • Scheuba C.
        • Niederle B.
        Current trends in surgery for renal hyperparathyroidism (RHPT)—an international survey.
        Langenbeck Arch Surg. 2013; 398: 121-130
        • Felsenfield A.J.
        Considerations for the treatment of secondary hyperparathyroidism in renal failure.
        J Am Soc Nephrol. 1997; 8: 993-1004
        • Cohen E.P.
        • Moulder J.E.
        Parathyroidectomy in chronic renal failure: has medical care reduced the need for surgery?.
        Nephron. 2001; 89: 271-273
        • Rothmund M.
        • Wagner P.K.
        • Schark C.
        Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: A randomized trial.
        World J Surg. 1991; 15: 745-750
        • Koonsman M.
        • Hughes K.
        • Dickerman R.
        • Brinker K.
        • Dunn E.
        • Feliciano D.V.
        • et al.
        Parathyroidectomy in chronic renal failure.
        Am J Surg. 1994; 168: 631-635
        • Madorin C.
        • Owen R.P.
        • Fraser W.D.
        • Pellitteri P.K.
        • Radbill B.
        • Rinaldo A.
        • et al.
        The surgical management of renal hyperparathyroidism.
        Eur Arch Oto-Rhino-Laryngol. 2012; 269: 1565-1576
        • Cheung P.S.
        • Borgstrom A.
        • Thompson N.W.
        Strategy in reoperative surgery for hyperparathyroidism.
        Arch Surg. 1989; 124: 676-680
        • Phitayakorn R.
        • McHenry C.R.
        Parathyroidectomy: overview of the anatomic basis and surgical strategies for parathyroid operations.
        Clin Rev Bone Miner Metab. 2007; 5: 89-102
        • Rothmund M.
        • Wagner P.K.
        Total parathyroidectomy and autotransplantation of parathyroid tissue for renal hyperparathyroidism. A one- to six-year follow-up.
        Ann Surg. 1982; 197: 7-16
        • Chou F.F.
        • Lee C.H.
        • Chen H.Y.
        • Chen J.B.
        • Hsu K.T.
        • Sheen-Chen S.M.
        Persistent and recurrent hyperparathyroidism after total parathyroidectomy with autotransplantation.
        Ann Surg. 2002; 235: 99-104
        • Yoon J.H.
        • Nam K.H.
        • Chang H.S.
        • Chung W.Y.
        • Park C.S.
        Total parathyroidectomy and autotransplantation by the subcutaneous injection technique in secondary hyperparathyroidism.
        Surg Today. 2006; 36: 304-307
        • Tan C.C.
        • Cheah W.K.
        • Tan C.T.
        • Rauff A.
        Intramuscular injection of parathyroid autografts is a viable option after total parathyroidectomy.
        World J Surg. 2010; 34: 1332-1336
        • Bergenfelz A.
        • Lindbolm P.
        • Tibblin S.
        • Westerdahl J.
        Unilateral versus bilateral neck exploration for primary hyperparathyroidism: five-year follow-up of a randomized controlled trial.
        Ann Surg. 2002; 246: 976-980
        • Stanbury S.W.
        • Lumb G.A.
        • Nicholson W.F.
        Elective subtotal parathyroidectomy for renal hyperthyroidism.
        Lancet. 1960; 275: 793-798
        • Iyer N.G.
        • Shaha A.R.
        Complications of thyroid surgery: prevention and management.
        Minerva Chir. 2010; 65: 71-82
        • Messa P.
        • Castelnovo C.
        • Scalamogna A.
        Calcimimetics in peritoneal dialysis patients.
        Contrib Nephrol. 2012; 178: 143-149