The effect of surgical procedures on short-term and long-term outcomes of the patients in secondary hyperparathyroidism
Ethem Sahan1, Ahmet Dag1, Mustafa Berkesoglu1, Mehmet Ali Sungur2, Ahmet Koray Ocal1, Tamer Akca1
1Mersin University Faculty of Medicine, Department of General Surgery, Mersin, Turkey
2Duzce University, Department of Biostatistics and Medical Informatics, Duzce, Turkey
Keywords: Parathyroid, parathyroidectomy, secondary hyperparathyroidism, T-score, vitamin D
Background: Management of patients with secondary hyperparathyroidism (SHPT) is mainly medical. When medical treatment fails, subtotal parathyroidectomy (subtotal PTX) or total parathyroidectomy and authotransplantation (total PTX+AT) are standard procedures. But there is no globally accepted unique surgical procedure. We aimed to evaluate the effect of operation types on short-term and long-term outcomes in patients with SHPT who had 3 or 4 parathyroid glands exploration in surgery.
Material and methods: This study was included patients with SHPT who undergone PTX. Patients were divided into 3 groups: 3 PTX in Group A, subtotal PTX in Group B and total PTX+AT in Group C. Parathormone (PTH), calcium, phosphorous, 25-hydroxy-vitamin-D (25-OH Vit-D) levels, bone densitometry scores, persistence/recurrence rate and complaints were evaluated and compared before/after operation between the groups.
Findings: Six, eight and nine patients were situated in Group A, B and C, respectively. PTH levels decreased at 6th months in all groups, but elevated again in Group A. Patients had lower PTH, phosphorous and serum 25OH Vit-D levels; better T-score and improvement in pruritis, prominently in Group B and C postoperatively during the follow-up.
Conclusion: In conclusion, removing of fewer than 3,5 glands were accepted as inappropriate surgery in SHPT. Surgeons should attribute to find out at least 4 parathyroid glands. Total PTX+AT and subtotal PTX in SHPT is significantly associated with stable lowered PTH levels and persistence/recurrence rates.