Advances on recurrence of secondary hyperparathyroidism after parathyroidectomy

doi:10.3969/j.issn.1674-490X.2022.01.006

Abstract

Abstract: Disturbance of calcium and phosphorus metabolism in chronic renal failure patients with long-term dialysis can cause compensatory hyperplasia of parathyroid gland and the increase of intact parathyroid hormone(iPTH)known as renal hyperparathyroidism(HPT)or secondary hyperparathyroidism(SHPT),clinical manifestations can include high parathyroidin, high calcium or hypocalcemia, and persistent high phosphorus. It can lead to diseases of skeletal system, neuropsychiatric system, blood system and cardio-cerebrovascular system, seriously affecting the quality of life and life span. The 2017 Global Guidelines for Kidney Disease recommend Chronic Kidney Disease(CKD)stage 3-5 complicated with severe hyperparathyroidism that does not respond to drug therapy, and parathyroidectomy is recommended. The problem of postoperative recurrence rate affects the further promotion of surgery. Although ultrasound and radionuclide scanning techniques have become more sophisticated in the past few years, it is still not possible to ensure complete preoperative localization of all parathyroids, especially those with less hyperplasia. The recurrence rate of subtotal resection and total resection plus autologous transplantation is higher than that of total resection, so total resection is more recommended for the prevention of recurrence. In addition, the improvement of preoperative localization, thymotomy, intraoperative parathyroid hormone monitoring and intraoperative nerve monitoring also contributed to the reduction of postoperative recurrence.

Key words: secondary hyperparathyroidism, recurrence rate, renal transplantation, intraoperative parathyroid hormone

CLC Number:

JIN Qiu, LIANG Yulong. Advances on recurrence of secondary hyperparathyroidism after parathyroidectomy[J]. Journal of Hebei Medical College for Continuing Education, 2022, 39(1): 41-48.

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