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

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Abstract

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.

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Abbreviations

AT-HPT:

Autotransplantion-hyperparathyroidism

rSHPT:

Recurrence of secondary hyperparathyroidism

AT:

Autotransplant

SHPT:

Secondary hyperparathyroidism

PTG:

Parathyroid gland

PTH:

Parathyroid-hormone

SPTX:

Subtotal parathyroidectomy

TPTX:

Total parathyroidectomy with or without autotransplantation

iPTH:

Intra-operative parathyroidhormone measurement

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Surgery, University Hospital Regensburg, Franz-Josef-Strauss Allee 11, 93053, Regensburg, Germany

    Ayman Agha, Martin Loss, Hans Jürgen Schlitt & Marcus N. Scherer

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  1. Ayman Agha
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  2. Martin Loss
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  3. Hans Jürgen Schlitt
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  4. Marcus N. Scherer
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Correspondence to Marcus N. Scherer.

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Agha, A., Loss, M., Schlitt, H.J. et al. Recurrence of secondary hyperparathyroidism in patients after total parathyroidectomy with autotransplantation: technical and therapeutic aspects. Eur Arch Otorhinolaryngol 269, 1519–1525 (2012). https://doi.org/10.1007/s00405-011-1776-7

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