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.”