Background: Renal hyperparathyroidism (HPTH) is a common complication of chronic kidney disease and is known to cause significant morbidity in these patients. There has been substantial debate on the best possible treatment of this condition. Surgical treatment is now considered to be of vital importance as its efficacy is well documented. The present study reported the outcome of parathyroidectomy in King Chulalongkorn Memorial Hospital, a university hospital in Bangkok, Thailand.

Objective: To determine surgical outcomes, including success rate and perioperative complications of parathyroidectomy in patients with renal HPTH.

Materials and Methods: The data was collected by retrospective review of patients’ records between June 2014 and May 2019. One hundred ten patients were enrolled. Their demographic data, laboratory results, and outcomes were collected and categorized.

Results: Among 110 patients, men accounted for 48.6%. The mean age was 49.5 years (SD 13.3). The most frequent operation was total parathyroidectomy with autotransplantation (TPTX+AT). All four glands were identified and excised in 84.5% of all patients. The mean preoperative serum intact parathyroid hormone (iPTH) level was 1,938 pg per dL with a range of 171 to 5,000 pg per dL. Postoperative hypocalcemia requiring intravenous calcium supplement was present in 70%. Postoperative cardiovascular complication occurrences were 16.4%, with one mortality due to myocardial infarction. In addition, one patient suffered unilateral recurrent laryngeal nerve injury, while two had stroke. The overall success rate of treatment was 81.1%, with 7.3% and 8.2% of patients that had persistently high PTH and recurrence of HPTH, respectively.

Conclusion: Parathyroidectomy is an essential choice of treatment in patients with renal HPTH. Further validation of correlations with other factors is now being processed, and more data are needed.

Keywords: Secondary hyperparathyroidism; Tertiary hyperparathyroidism; Chronic kidney disease mineral bone disease; Parathyroidectomy

DOI: 10.35755/jmedassocthai.2022.01.13231

Received 26 July 2021 | Revised 21 November 2021 | Accepted 29 December 2021