European Archives of Oto-Rhino-Laryngology

, Volume 269, Issue 5, pp 1519–1525 | Cite as

Recurrence of secondary hyperparathyroidism in patients after total parathyroidectomy with autotransplantation: technical and therapeutic aspects

  • Ayman Agha
  • Martin Loss
  • Hans Jürgen Schlitt
  • Marcus N. Scherer
Head and Neck


Recurrence of secondary hyperparathyroidism (rSHPT) in patients after total parathyroidectomy (TPTX) with autotransplantation (AT) represents a major diagnostic and therapeutic challenge. The aim of this retrospective cohort study was to evaluate rSHPT in patients after TPTX with AT and the subsequent surgical treatment. 112 patients with secondary hyperparathyroidism (surgery 1998–2008) were evaluated. In 16 patients, rSHPT was detected, while all of them had been originally operated with TPTX, cervical thymectomy and AT. The recurrence rate of TPTX with AT in our patient cohort was 14.2% (16/112). All the 16 patients with rSHPT suffered from forearm-autotransplant(s) hyperparathyroidism (AT-HPT). AT-HPT was diagnosed after a median of 5.6 years (1.5–11 years). All “forearm” AT-HPT operations were performed using the method of intra-operative parathyroid-hormone measurement. The histopathologic result showed hyperplasia or an adenoma of the reimplanted parathyroid gland (PTG) particles. The parathyroid hormone measurement (PTH) showed normal values in all cases 2 weeks after surgery. In none of the patients persistent hypocalcemia was observed. Our data demonstrates that the high rate of rSHPT in patients after TPTX with AT with renal-insufficiency represents an unsolved problem, often leading to re-operation including possible morbidity. Although we are not showing direct data, we propose, that the alternative method of TPTX without AT, simultaneous cryopreservation and potential metachronous reimplantation could offer an excellent alternative. However, this therapy option needs to be validated in further clinical trials.


Secondary hyperparathyroidism Parathyroidectomy with autotransplantation Recurrence Autotransplant(s)-hyperparathyroidism Re-operation Possible metachronous autotransplantation 





Recurrence of secondary hyperparathyroidism




Secondary hyperparathyroidism


Parathyroid gland




Subtotal parathyroidectomy


Total parathyroidectomy with or without autotransplantation


Intra-operative parathyroidhormone measurement


Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Ayman Agha
    • 1
  • Martin Loss
    • 1
  • Hans Jürgen Schlitt
    • 1
  • Marcus N. Scherer
    • 1
  1. 1.Department of SurgeryUniversity Hospital RegensburgRegensburgGermany

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