P016 and OC4
Total parathyroidectomy for renal hyperparathyroidism:
Autotransplantation and thymectomy are unnecessary steps for a good outcome. Long term follow up series.
J E Coulston, R J Egan, E Willis, J D Morgan.
Department of Endocrine Surgery, North Bristol NHS Trust, Bristol, BS10 5NS
Parathyroidectomy for renal hyperparathyroidism is the gold standard treatment although controversy exists as to the optimal surgical procedure. Total parathyroidectomy without either autotransplantation or thymectomy is one suggested approach. This study reviewed the medium to long term results of this procedure as well as comparing it to other surgical techniques.
A retrospective review of patients undergoing total parathyroidectomy between August 2000 and March 2009 was undertaken. The procedure was performed by a single surgeon and median follow up was 31 months (1-120).
Data was obtained on 115 patients with no re-explorations for bleeding or clinical recurrent laryngeal nerve injuries. Post-operative hypocalcaemia rate was 15.6% . Thirty three (28.7%) patients had an undetectable parathyroid hormone level at the end of follow-up. Fourteen (12.2%) patients developed recurrent hyperparathyroidism with a median parathyroid hormone level of 35.4 pmol/L (range 5.4-200). The re-operation rate was 3.5%. Thymectomy tissue, taken if 4 glands could not be identified, revealed no parathyroid glands.
Total parathyroidectomy has minimal associated morbidity or mortality and a recurrence rate superior to other surgical procedures. It is a sound procedure for a good clinical outcome and should be the treatment of choice in patients with renal hyperparathyroidism.