RESULTS OF PARATHYROIDECTOMY IN PATIENTS WITH CHRONIC RENAL FAILURE

Abstract

Four patients underwent parathyroidectomy for secondary and tertiary hyperparathroidism. Three of the patients were male and the mean age was 41. Four patients had undergone previous renal transplantation of whom two had returned to hemodialysis because of rejection. All patients who experienced fatigue, pruritus, anemia, uncontrollable hypertension and pain of skeletal system, had normal serum calcium with increased phosphate and alkaline phosphatase levels. In all patients intact parathormone level was above 1000pg/ml. In order to determine the localization of the parathyroids, ultrasound, computerized tomography and thalium-technetium substraction scintigraphy were performed. Surgical exploration of the two patients revealed 4 hyperplastic parathyroids of which lower ones were inside the thymic remmant. In one patient 3 parathyroids were identified and a subtotal thyroidectomy was performed for the missing side. Two hyperplastic parathyroids were found in the patient who had bilateral subtotal thyroidectomy previously. Subtotal parathyroidectomy in one patient and parathyroidectomy and autotransplantation in three patients were performed. All patients became asymptomatic and calcium, phosphate and parathormone levels returned to normal in the follow-up at an average of 24.5 months.