Surgery for secondary hyperparathyroidism. Total or subtotal?

Objectives Secondary hyperparathyroidism (sHPT) develops as a result of the chronic parathyroid stimulation associated with hypocalcemia, hyperphosphatemia, or vitamin D deficiency and leads to an increase in parathormone (PTH) synthesis and parathyroid cell proliferation in all of the four glands. Background There are currently three surgical approaches to the treatment of renal hyperparathyroidism: subtotal parathyroidectomy, total parathyroidectomy without autotransplantation, and total parathyroidectomy with autotransplantation. Methods Included in the study were 79 of which 35 underwent a total parathyroidectomy with autotransplantation (TPTX+AT), while 44 patients underwent a subtotal parathyroidectomy (SPTX). Results A significant decrease was noted in PTH, calcium, and phosphate levels following both types of parathyroidectomy. It was observed that PTH and phosphate serum levels were controlled significantly better following a total parathyroidectomy with autotransplantation, and the recurrence rate was higher in the subtotal parathyroidectomy group (14.3% vs. 27.3%). Conclusion Considering its significantly superior outcomes in the short- and long-term, total parathyroidectomy with autotransplantation should be the preferred treatment option in countries where access to kidney transplantation is difficult and where healthcare services are expensive.