Subtotal Parathyroidectomy for SHPT Safe, Effective
Cure rate is significantly higher among patients who have intraoperative monitoring of intact parathyroid hormone level.
Subtotal parathyroidectomy may be an effective and safe treatment for patients with renal disease and secondary hyperparathyroidism (SHPT), according to the results of a new study.
The study, which was retrospective, involved 297 patients with end-stage renal disease (ESRD) and SHPT. Of these, 268 underwent subtotal parathyroidectomy and 29 underwent incomplete parathyroidectomy. Investigators used intraoperative intact parathyroid hormone (iPTH) assays in 69.7% of explorations.
Persistent SHPT was present in 12 (4.5%) patients who underwent subtotal parathyroidectomy patients and 5 patients (17.2%) of those who had incomplete parathyroidectomy, Aleksander Konturek, MD, and colleagues at Jagiellonian University College of Medicine in Krakow, Poland, reported in Langenbeck's Archives of Surgery (2016;401:965-974). The patients operated on with intraoperative iPTH assays had a significantly higher cure rate than patients not monitored with the assays (97.1% vs 87.8%). Only 1 patient died in the hospital.
The researchers found that hungry bone syndrome occurred in a significantly greater proportion of subtotal parathyroidectomy patients than those who underwent incomplete parathyroidectomy (31.3% vs 6.9%).
The investigators concluded that subtotal parathyroidectomy is a safe and efficacious treatment for SHPT in patients with renal disease and use of an intraoperative iPTH assay can guide surgical exploration and improve the cure rate.
The study population had a mean age of 44.5 years and a mean follow-up of 24.6 months. Primary or secondary glomerular or tubular damage was the most common cause of ESRD (81.5% of patients).
1. Konturek A, Barczyński, Stopa M, Nowak W. Subtotal parathyroidectomy for secondary renal hyperparathyroidism: a 20-year surgical outcome study. Langenbecks Arc Surg 2016;401:965-974.