Both total parathyroidectomy (PTx) with autotransplantation and subtotal PTx proved successful in treating secondary hyperparathyroidism (SHPT) and preventing its recurrence, according to a new review.

Given a debate on which procedure is best for SHPT, a team from Qianfoshan Hospital at Shandong University in China led by Juan Chen and Xiaoyan Jia, performed a systematic review of 13 studies published over the last 3 decades up to May 10, 2015. They used the Newcastle-Ottawa Scale to determine the quality and risk of bias of each study, which originated in Europe, the United States, or Asia. Of 1,589 renal failure patients, 1,064 had total PTx with autotransplantation and 621 had subtotal PTx.

According to meta-analysis results published in Nephrology, there were no statistically significant differences between procedures in symptom improvement, radiologic improvement in bone disease, SHPT persistence or recurrence, and reoperation. Effects of the 2 surgeries on serum calcium and parathyroid hormone (PTH) were also similar. Few data were available to evaluate the risk of cardiovascular complications and all-cause mortality.

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“Although SPTX [subtotal PTx] was related with seemingly higher rate of symptomatic and imaging examination improvement, and lower reoperation rate, the difference was not statistically significant,” the investigators wrote. “Systematic review also indicated that both procedures could effectively lower the serum level of PTH and calcium.”

A recent randomized trial by Radu Mircea Neagoe, et al. published in Endokrynologia Polska showed similar results for both remnant-conserving procedures in a small number of patients.

As most studies in the meta-analysis were retrospective, the researchers encouraged additional prospective, randomized controlled trials with greater statistical power to clarify the effects of the 2 surgeries on patient safety over the long term.


  1. Chen J, Jia X, Kong X, Wang Z, Cui M, Xu D. Total parathyroidectomy with autotransplantation versus subtotal parathyroidectomy for renal hyperparathyroidism: a systematic review and meta-analysis. Nephrology (Carlton). doi: 10.1111/nep.12801.