Abstract
An operative case of secondary hyperparathyroidism uncontrolled by percutaneous ethanol injection therapy (PEIT) was reported. A 52-year-old woman with secondary hyperparathyroidism due to hemodialysis for renal failure, who had undergone PEIT of the parathyroid glands several times, visited our hospital for surgery. MRI and US demonstrated a slight swelling of the four parathyroid glands, and laboratory examinations showed the high level of serum calcium and intact parathyroid hormone. She underwent total parathyroidectomy with autotransplanation. Two parathyroid glands, the right-inferior and left-inferior parathyroid glands, underwent PEIT preoperatively. In surgery, the parathyroid glands except the right-superior one adhered to the surrounding tissue, the recurrent laryngeal nerve and the thyroid gland among others, so the surgical procedure was very difficult. Histologically, a fibrous change caused by PEIT was observed in the right-inferior gland. On the other hand, there was no conspicuous change in the left-inferior one. Postoperatively, the level of serum calcium and intact parathyroid hormone decreased to within a normal range. One year and 6 months have passed without any sign of recurrence.
