Abstract
Total parathyroidectomy and autotransplantation of parathyroid tissue were performed in ten hemodialysis patients. During the preoperative period, bone pain appeared in all patients, pruritus in 4, calcaneus fracture, rib fracture and Achilles tendon rupture in one respectively, and clubbed fingers in 4. Salt and pepper appearance of the skull x-ray and subperiosteal resorption in hand x-ray appeared in all patients. Preoperatively the averaged serum calcium (Ca) was 5.1mEq/l, phosphorus (P) 4.8mg/dl, alkaline phosphatase (ALP) 53.0KA units and PTH 38.3ng/ml.
The parathyroid glands of all patients were visualized by computed tomography (CT) and/or scintigraphy with 201TICI and 99mTcO4-. Total parathyroidectomy and autotransplantation of parathyroid tissue were performed in all patients by Wells' method, and they were followed up from 3 to 16 months (mean, 10 months).
Four or more glands were removed in 9 out of ten patients. Only one gland was removed in one patient. Excised parathyroid tissues were immediately autografted into a forearm muscle. The removed parathyroid glands weighed from 787 to 8, 100mg/patient (mean 3, 819mg/patient). The weight of the removed parathyroid glands was significantly correlated with the preoperative PTH level (r=0.706, p<0.05). Histological appearances were chief cell hyperplasia in all patients and oxyphil cell hyperplasia in one patient. CT and/or scintigraphy visualized 22 of 25 parathyroid glands (88%), weighing more than 500mg/gland.
Itching, bone pain, bone fracture and tendon rupture were improved, but clubbed fingers did not recover. PTH decreased immediately after parathyroidectomy. The function of the autografted tissue of the parathyroid was demonstrated by the PTH from the anticubital vein of the grafted arm compared with that of the nongrafted arm. Bones were examined radiologically 3 to 24 months after parathyroidectomy. The salt and pepper appearance of the skull was improved in 8 out of ten patients, and subperiosteal resorption of the fingers was significantly improved in 9. Two patients complained of bone pain without elevated PTH one and 15 months after parathyroidectomy, respectively.
Total parathyroidectomy and autotransplantation of the parathyroid tissue were performed safely and were effective in treating the secondary hyperparathyroidism in chronic hemodialysis patients. But in two patients, bone pain reappeared. The indication of total parathyroidectomy will be further considered more precisely.
