SHPT Surgical Procedures Equally Effective

Randomized study compared total parathyroidectomy with and without autotransplantation.
Randomized study compared total parathyroidectomy with and without autotransplantation.

Total parathyroidectomy with or without autotransplantation is safe and equally effective for the surgical management of otherwise uncontrollable secondary hyperparathyroidism (SHPT), according to a new study.

Total parathroidectomy alone, however, seems to suppress parathyroid hormone (PTH) more effectively, investigators reported.

In a randomized, controlled pilot study, Katja Schlosser, MD, of Agaplesion Evangelisches Krankenhaus Mittelhessen in Giessen, Germany, and colleagues compared total parathyroidectomy (TPTX) alone and TPTX with autotransplantation (TPTX+AT) in 100 patients on long-term dialysis and otherwise uncontrollable SHPT. The main outcome was rate of recurrent disease within a 3-year follow-up period after surgery.

Of the 100 patients, 52 underwent TPTX and 48 TPTX+AT. The 2 groups had similar patient characteristics, duration of surgery (2.29 vs 2:47 hours, respectively), and mean hospital stay (10 vs 8 days), Dr Schlosser's group reported in Annals of Surgery (2016;264:745-753).

The groups did not differ significantly with respect to patient characteristics, preoperative baseline data, and serum calcium values (2.1 and 2.1 mg/dL). None of the TPTX patients experienced recurrent SHPT compared with 4 TPTX+AT patients. Persistent SHPT developed in 1 TPTX patient and 2 TPTX+AT patients. PTH increased in the TPTX+AT group, and it was significantly higher at the end of follow-up compared with the TPTX group (98.2 vs 31.7 pg/mL).

The investigators concluded that “TPTX seems to be a feasible alternative therapeutic option for the surgical treatment of SHPT.”

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