Endocrine Abstracts

Subtotal parathyroidectomy (SPX) and total parathyroidectomy with autotransplantion (TPXAT) are adequate techniques in treatment of secondary hyperparathyroidism (HPT2) in hemodialysed patients with identical results. Reinterventions required for persistence or recurrence of HPT2 may seem easy after TPXAT: no redo-surgery in the cervical area and removal of grafts in the forearm under local anaesthesia. The aim of this study was to analyze our results of reiterative surgery in HPT2.

Between 1981 and 2010, 44 hemodialysed patients were reoperated for HPT2 in our tertiary referral centre. Twelve cases were excluded for missing data or an incomplete primary intervention. Five patients were operated initially elsewhere. Primary interventions consisted of 18 SPX and 14 TPXAT that were performed correctly. Male/female ratio was 3:5. Operative indication for reintervention was PTH-level >500 pg/ml (mean: 967 pg/ml). Localization studies included cervical ultrasound and MIBI-scintigraphy, plus CT-scan or invasive PTH-gradient measurent if necessary.

Mean time to reintervention was 60 and 111 months after SPX and TPXAT respectively (P<0.05). After SPX two patients had persisting hypercalcemia caused by a mediastinal supernumerary gland and inadequate judgment of the parathyroid remnant size. Twelve patients had recurrence following SPX caused by remnant hyperplasia and four patients had a supernumerary gland (n=4). 81% was cured after 1.1 reoperation without any postoperative morbidity. Following TPXAT, no persistence occurred and recurrence was caused by hyperplasia on parathyroid autografts (n=11) and by supernumerary glands (n=4). Significantly more imaging studies were required for localization of pathological parathyroid tissue after TPXAT. 79% was cured after 2 (mean) reinterventions (P<0.05).

In our experience reoperations for persistent or recurrent HPT2 were not easier to perform after TPXAT than after SPX.