Clinical course after total parathyroidectomy without autotransplantation in patients with end-stage renal failure

In patients with chronic renal failure, hyperparathyroidism is a common pro blem and surgical parathyroidectomy (PTX) is frequently required. The three different surgical approaches are subtotal PTX, total PTX with autotranspl antation, and total PTX without autotransplantation. Recurrence of hyperpar athyroidism varies from 5% to 80% in different studies for the first two su rgical approaches. To minimize the risk for recurrence, and because we fear severe relapses with calciphylaxia, we perform total PTX without autotrans plantation. From October 1993 to October 1997, 20 patients (9 men and 11 wo men) underwent total PTX without autotransplantation (median age, 52 years; range, 23 to 74 years; median dialysis time before PTX, 6.5 years; range, 1 to 22 years). All patients were supplemented with vitamin D analogues pos toperatively. Patients were followed up for 1 to 48 months (median, 20 mont hs). Bone pain, when present, disappeared within the first week after total PTX. Postoperatively, most patients had temporary hypocalcemia. In the lon g term, five patients had asymptomatic hypocalcemia. One patient, however, repeatedly had hypocalcemic seizures. Five patients developed asymptomatic hypercalcemia when supplemented with calcitriol. At the end of the individu al's observation time, parathyroid hormone (PTH) levels were less than norm al in six patients, normal in seven patients, and increased in seven patien ts despite total PTX. We conclude that total PTX should be reconsidered an option for the treatment of hyperparathyroidism secondary to renal failure. There was no evidence of clinical bone disease after total PTX. Apparently , remaining ectopic parathyroid tissue accounts for PTH levels after total PTX. (C) 1999 by the National Kidney Foundation, Inc.