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2010 Annual Meeting Abstracts

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Initial Parathyroid Surgery in 606 Patients With Secondary Hyperparathyroidism - What is the Optimal Surgical Procedure?
*Ralph Schneider, *Detlef K Bartsch, *Katja Schlosser
Philipps University Marburg, Marburg, Germany

Objective
Clinical and surgical findings of patients who underwent initial parathyroidectomy (PTX) for otherwise uncontrollable secondary hyperparathyroidism (sHPT) were evaluated. Different surgical procedures applied were compared to determine the optimal one.
Design
Analysis of a prospective database
Setting
Tertiary referral center
Patients
606 patients who underwent initial PTX between 1976 and 2010
Main Outcome Measures
Data were analyzed regarding perioperative biochemical changes, surgical procedures and postoperative outcome.
Results
Total PTX with autotransplantation and cervical thymectomy (group A) was performed in 504, total PTX without autotransplantation in 32 (group B), subtotal PTX in 21 patients (group C) and incomplete PTX in 49 patients (group D).
After surgery, mean calcium dropped from 2.76 to 1.91mmol/l in group A, from 2.67 to 2.11mmol/l in group B, from 2.70 to 2.09mmol/l in group C and from 2.65 to 1.88mmol/l in group D. PTH dropped from 1371.4pg/ml to 28.8pg/ml in group A, from 1078.4pg/ml to 27.0pg/ml in group B, from 2377.9pg/ml to 61.4pg/ml in group C and from 1010.2pg/ml to 99.5pg/ml in group D. Persistent sHPT occurred in 2/504 patients of group A (0.4%), 0/32 patients of group B (0%), 1/21 patients of group C (4.8%) and 2/49 patients in group D (4.1%).
Mean follow-up was 57.6 months. Recurrent sHPT occurred in 27/504 patients of group A (5.4%), 0/32 patients of group B (0%), 2/21 patients of group C (9.5%) and 3/49 patients of group D (6.1%).
Conclusions
All surgical procedures demonstrated an effective lowering of calcium and PTH. Regarding the rate of recurrent or persistent disease, total PTX without autotransplantation has to be considered as the optimal surgical procedure for patients with otherwise uncontrollable sHPT.


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