Long term results of total parathyroidectomy/auto transplantation without cryopreservation in secondary hyperthyroidism

Secondary hyperparathyrodism, is a common complication in patients with chronic renal failure, and the incidence is 2,5 % despite the medical therapy for reducing the progression of the disease . In our study, we aimed to compare the efficacy and early-late results of subtotal parathyroidectomy and total parathyroidectomy/auto transplantation without cryopreservation. Between 2003-2009, 68 patients with secondary hyperparathyrodism who had parathyroidectomy were analysed retrospectively. In group1 subtotal parathyroidectomy, in group2 total parathyroidectomy/auto transplantation without cryopreservation were performed in our clinic. Patients demographic characteristics, duration of the operation, number of glands with the disease, features of concurrent thyroidectomy, thymectomy and frozen pathology, and postoperative calcium, phosphor, parathormone and alkaline phosphatase levels (at the 48th hour, first week, third month, sixth month and twelfth week of the operation) were evaluated. In group1 8 patients (14.9%), in group2 17 patients (76.2%) had concurrent thymectomies. The rates of persistant hyperparathyrodism in group1 and group2 were 14.9% (n=7), 4.8% (n=1) respectively. In group2 no recurrent hyperparathyroidism was seen, in group2 10.6% (n=5) of the patients had recurrent hyperparathyroidism. The reasons of persistant and recurrent hyperparathyroidism were ectopic or supernumerary glands in 69.2% (n=9) of the patients. In subtotal parathyroidectomy technique, increased rate of parathyromatosis and remnant tissue hyperplasia are responsible for recurrent hyperparathyroidism. Concurrent bilateral thymectomy in surgical procedure can decrease incidence of persistant and recurrent hyperparathyroidism in the presence of ectopic and supernumerary glands. In patients with end stage renal failure and secondary hyperparathyrodism, bilateral cervical thymectomy concurrent with total parathyroidectomy/auto transplantation without cryopreservation can be applied as a safe and efficant surgical procedure.