PARATHYROIDECTOMY IN CHRONIC-RENAL-FAILURE - COMPARISON OF 3 OPERATIVE STRATEGIES

The efficacy of subtotal parathyroidectomy (n = 11), total parathyroid ectomy+autotransplantation (n = 13) and total parathyroidectomy alone (n = 24) were compared in a series of renal patients with hyperparathy roidism. The principal indication for surgery was severe bone disease but other indications were uncontrolled hypercalcaemia, soft tissue ca lcification and grossly elevated parathyroid hormone (PTH) levels. The clinical success rates at 24 months follow-up for subtotal, total plu s autograft, and total parathyroidectomy were 100, 89 and 97% respecti vely. Similar improvements in radiological changes and alkaline phosph atase levels were seen in all three groups. Recurrent hyperparathyroid ism was recorded in three (27%) members of the subtotal parathyroidect omy group and two (16%) of the patients undergoing total parathyroidec tomy and autotransplantation. Two patients required re-exploration of their fore-arm parathyroid autograft. No patients undergoing total par athyroidectomy only suffered persistent-or recurrent hypercalcaemia Vi tamin D analogue requirements rates in patients undergoing subtotal, t otal plus autotransplant, and total parathyroidectomy at 24 months wer e 44, 70 and 81% respectively. An important finding is the demonstrati on of residual parathyroid function in 14/16 patients (87.5%) undergoi ng total parathyroidectomy without autotransplantation and followed-up for 2 years.