Analysis of diagnostic and therapeutic modalities in parathyroidectomy cases due to secondary hyperparathyroidism in childhood

There are few reports about parathyroidectomy due to secondary hyperparathyroidism in patients with end stage renal failure in literature. Baskent University Research Center-a transplant center-had more patients with end stage renal failure than the other centers In this report, we aimed to assess the diagnosis and treatment methods of secondary hyperparathyroidism due to the end stage renal faiure patients in our center. 16 patients made surgical treatment for secondary hyperparathyroidism between 1999-2010 years in Baskent University Research Center Pediatric Surgery Clinic included into the study. Demographical data, laboratory findings before and after the surgery and imagining methods were all examined. Effect of the Technetium 99m methoxyisobutylisonitrile (Tc-99m-MIBI) probe sensitive to gamma rays dedection was also evaluated to locate and identify all of the parathyroid glands during the operation. In 75% cases, parathyroid scintigraphy and ultrasonography imagining methods determined the parathyroid pathology, however; they were insufficient for differential diagnosis. All of the four paratiroid glands were identifed in the four of nine patients, and there were three parathyroid glands were identified in the other patients. During the operation, four parathyroid glands were located eight cases of 11 patients (73%) and three parathyroid glands were located in other three patients using probe sensitive to gamma rays dedection. Subtotal thyroidectomy was made to one of four patients who had located four glands and total thyroidectomy and parathyroid autoimplantation was done the other eight patients. All patients had a diagnosis of parathyroid hyperplasia after the histopathological examination. The comparison of laboratory findings before and after the surgery, there was a significant relation between the decrease of serum parathyroid hormon and calcium levels (p<0,05). Total parathyroidectomy and parathyroid autoimplantation is the most efficent and safe management for the secondary parathyroidism patients. During the surgery using probe sensitive to gamma rays detection may also help the surgeon. This procedure have an important role on shortening the time and the success of the surgery apart from the surgeon's experience.