Tertiary hyperparathyroidism in patients on hemodialysis for chronic renal failure: subtotal parathyroidectomy or conservative treatment?

BACKGROUND

To report our experience in novel surgical strategy in the treatment of tertiary hyperparathyroidism in hemodialysis patients for chronic renal failure and to assess the impact of this type of surgery on postoperative clinical and laboratory variables in this population.

METHODS

Fifteen hemodialysis (12 female and 3 male) patients with chronic renal failure were operated on for tertiary hyperparathyroidism. Cervical ultrasound was performed in all patients (n = 15).

RESULTS

Preoperative cervical ultrasound showed one enlarged parathyroid gland (n = 4) or few enlarged parathyroid glands (n = 11). Group I consisted of four patients with single parathyroid gland enlargement on ultrasound. These patients underwent resection of only the enlarged gland; three by unilateral approach under local anesthesia and one by cervicotomy under general anesthesia. Group II consisted of 11 patients with enlargement of all parathyroid glands on ultrasound. These patients were assumed to have hyperplasia and underwent subtotal parathyroidectomy (3.5 glands) and thymectomy by cervicotomy under general anesthesia. Postoperatively, patients in group I were normocalcemic (n = 4) and patients in group II were normocalcemic (n = 4) or had transient hypocalcemia (n = 7). The pathology showed an adenoma in patients of group I (n = 4) and hyperplasia in patients of group II (n = 11). Postoperatively, both patients in Group I and II had a similar resolution of their symptoms.

CONCLUSION

Tertiary hyperparathyroidism secondary to chronic renal failure may be treated by parathyroidectomy of one or few enlarged parathyroid gland(s). Parathyroidectomy by unilateral approach under local anesthesia may be of value when preoperative localization studies show a single parathyroid gland enlargement.