What is the role of surgery in the treatment of secondary hyperparathyroidism?

Updated: Oct 02, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Indications for surgery include bone pain or fracture, pruritus, calciphylaxis (see Related Disorders), and extraskeletal nonvascular calcifications with elevated parathyroid hormone levels despite appropriate medical therapy. Parathyroidectomy can be considered in patients with severe hyperparathyroidism (persistent serum levels of intact parathyroid hormone greater than 800 pg/mL [88.0pmol/L]), associated with hypercalcemia and/or hyperphosphatemia that is refractory to medical therapy.

A study by Hsu et al indicated that in patients with severe secondary hyperparathyroidism resulting from end-stage renal disease, parathyroidectomy reduces the risk of peripheral arterial disease. In the end-stage renal disease patients who underwent parathyroidectomy (947 patients, 5.08-year follow-up), the incidence density rate of peripheral arterial disease was 12.26 per 1000 person-years, compared with 24.09 per 1000 person-years in those who did not undergo the surgery (3746 patients, 4.52-year follow-up). [37]

Mortality has been shown to be reduced in dialysis patients who undergo parathyroidectomy for severe secondary hyperparathyroidism.

Surgical treatment of severe secondary hyperparathyroidism may also improve quality of life. In a meta-analysis of patients with secondary hyperparathyroidism treated with cinacalcet or parathyroidectomy, quality of life was seen to improve after surgical treatment but not with medical therapy. [38] However, available studies into quality of life in such cases are observational, and randomized, comparative data are not available.


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