Parathormone levels after subtotal and total (autotransplantation). Parathyroidectomy for secondary hyperparathyroidism

To compare results of subtotal versus total parathyroidectomy with autotransplantation in dialysis patients with secondary hyperparathyroidism, pre- and postoperative calcium, phosphorus, alkaline phosphatase, and immunoreactive parathormone (iPTH) were measured. In eight patients with subtotal parathyroidectomy, the mean preoperative iPTH of 903 ± 139 μl-eq/ml decreased to a mean of 26.6 ± 9 μl-eq/ml, 6 to 29 months postoperatively. In six patients with total parathyroidectomy and autotransplantation the mean preoperative iPTH of 1289 ± 248 μl-eq/ml decreased to a mean peripheral iPTH of 32 ± 7 μl-eq/ml, 4 to 18 months postoperatively. Both groups were similar in (1) pre- and postoperative iPTH levels, (2) the absence of postoperative clinical or chemical hyperparathyroidism, (3) improvement in symptoms, and (4) demonstrable functioning parathyroid tissue. None of the patients required reexploration for persistent hyperparathyroidism. Subtotal parathyroidectomy and total parathyroidectomy with autotransplantation appear to be equally effective modalities for treatment of secondary hyperparathyroidism in patients with end-stage renal disease.