| Theme |
Hypoparathyroidism and Related Problems in Dialysis Patients |
| Title |
Parathyroid function after parathyroidectomy |
| Author |
Yoshihiro Tominaga |
Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital |
| Author |
Yuji Tanaka |
Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital |
| Author |
Hiroshi Takagi |
Department of Transplant Surgery, Nagoya 2nd Red Cross Hospital |
| [ Summary ] |
Parathyroid function after parathyroidectomy (PTx) is dependent on operative procedure, histopathological findings of remaining tissue and management of serum calcium and phosphate levels after PTx. Maintaning an optimal PTH level in hemodialysis patients, in order to prevent recurrent hyperparathyroidism (HPT) and to avoid hypoparathyroidism and low bone turnover after PTx, can be challenging. In our series of patients undergoing total PTx with a forearm autograft for renal HPT, serum PTH levels gradually rose and none of the patients required retransplantation of cryopreserved parathyroid tissue due to autograft failure. However, in about 40% of patients, the iPTH level was less than 65pg/ml at 3 years postoperatively. It is necessary to reevauate medical treatment after PTx. Graft-dependent recurrent HPT is not an insignificant clinical problem. Graft-dependent recurrence reaches approximately 20% by the 5th postoperative year. When a nodular hyperplastic gland was autografted, the incidence of recurrence was significantly higher than when a diffusely hyperplasiatic gland was transplanted. To prevent recurrence, diffusely hyperplastic tissue should be autografted. |