Abstract
Total parathyroidectomy with autotransplantation (PTx-AT) has been widely established as a treatment for secondary hyperparathyroidism (2°HPT). There have, however, been few reports on the long-term effects of this procedure. We evaluated changes in bone mineral content (∑GS/D, MCI) in 20 patients after PTx (11-63 months after PTx, mean 36 months) by the digital imaging processing (DIP) method. Furthermore, the function of the transplanted parathyroid glands in 27 post-PTx patients was evaluated by serum C-PTH value, PTH gradient, ultrasonography and 201TI scintigraphy. Increased ∑GS/D was observed in 14 of 20 (70%) patients. The increased rates of ∑GS/D correlated significantly with the preoperative levels of ALP, but not with postoperative period, age, sex, the dialysis duration before PTx, the preoperative levels of C-PTH or osteocalcin. In terms of the function of the transplanted parathyroid glands, the postoperative levels of C-PTH tended to rise gradually after PTx. In eight of 27 patients, the levels of C-PTH and intact-PTH at evaluation were less than 0.5ng/ml and 0.03ng/ml, respectively. However, the patients had no symptoms of hypoparathyroidism. The weights of the transplanted parathyroid glands did not correlate significantly with the postoperative levels of C-PTH. According to our results, PTx may not necessarily increase bone mineral content in the long term, but it can diminish the loss of bone mineral content associated with 2°HPT. Further study of the function of transplanted parathyroid glands is necessary before firm conclusions can be drawn.
