Objective: To analyse the efficacy of total parathyroidectomy with autotransplantation (total PTX + AT) in treating uremic secondary hyperparathyroidism and to discuss the relevant medical treatment used.
Methods: The clinical data of 31 patients with uremic SHPT admitted into our hospital from 1996-2005 were analysed with respect to total PTX + AT.
Results: The period of hemodialysis were for the patients was on the average 9.2 years. There were 22 male and 9 female with an average age of 42.4 (31 - 67) years. The clinical manifestations consisted of osteoarticular pain in 83.9%, fractures in 35.5%, soft tissue and vascular calcification in 45.2% and pruritus in 80.6%. Laboratory examination yielded the following results: haematocrit 0.25 +/- 0.04, serum Ca (2.61 +/- 0.35) mmol/L, serum P (2.14 +/- 0.31) mmol/L, plasma total alkaline phosphatase (AKP) (885 +/- 335) U/L and parathyroid hormone (iPTH) (1811 +/- 879) ng/L (700 - 2500 ng/L). Cervical ultrasonography and/or emission computed tomography showed 2 - 4 hyperplastic glands. All of the patients showed no response to medical treatment including vitamin D. Total PTX + AT was performed on the 31 cases. Clinical symptoms and signs markedly improved after operation in 1 to 2 weeks. However, fracture and ectopic calcification showed no improvement. Plasma iPTH decreased rapidly (< 200 ng/L) postoperatively in 1 to 2 days. Serum Ca and P returned to normal. AKP was corrected in 1 to 3 months.
Conclusion: Total parathyroidectomy with autotransplantation is an effective treatment for severe uremic secondary hyperparathyroidism patients.