Total parathyroidectomy without autotransplantation for renal hyperparathyroidism

Background: Parathyroidectomy is the standard treatment for renal hyperparathyroidism although controversy exists about 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. Methods: A retrospective review was undertaken of patients undergoing total parathyroidectomy between August 2000 and March 2009. The procedure was performed by a single surgeon and median follow-up was 31 (range 1-120) months. Results: Data were obtained on 115 patients with no re-explorations for bleeding or clinical recurrent laryngeal nerve injuries. The rate of postoperative hypocalcaemia on the day after surgery was 15.7 per cent. Thirty-three patients (28.7 per cent) had an undetectable parathyroid hormone level at the end of follow-up. Fourteen patients (12.2 per cent) developed recurrent hyperparathyroidism with a median parathyroid hormone level of 35.4 (range 5.4-200.0) pmol/l. The reoperation rate was 3.5 per cent. Thymectomy tissue, taken if all four glands could not be identified, revealed no parathyroid glands. Conclusion: Total parathyroidectomy alone has minimal associated morbidity or mortality, and a good medium-to long-term clinical outcome with a low recurrence rate.