Total parathyroidectomy: parathyroid hormone levels and supernumerary glands in hemodialysis patients.

Determination of PTH levels by radioimmunoassay can be employed for the accurate monitoring of the completeness of parathyroidectomy and the functioning of transplanted parathyroid tissue in chronic renal failure but the successful use of the approach requires accurate knowledge of the specificity of the assay and appropriate timing of postparathyroidectomy PTH measurements. In our series, 33% of grafts functioned within 9 days of implantation. The incidence of five, or more, glands in 25% of patients and the persistence of detectable PTH levels, postoperatively, in four patients after removal of four or more glands suggest that hypocalcemic stimulation in uremia may cause parathyroid rests ( parathyromatosis ) to enlarge. These findings also suggest that particular attention should be paid to finding a possible 5th or 6th parathyroid gland in uremic patients requiring surgical treatment of hyperparathyroidism.