[Surgical treatment of refractory hyperparathyroidism and usefulness of the intraoperative PTH]

To share our experience in the surgery of so-called refractory hyperparathyroidism (secondary and tertiary without response to therapy with calcitriol).

Retrospective study based on 41 patients-5 with secondary and 6 with tertiary hyperparathyroidism-referred by nephrology for surgical evaluation of their illness because of poor response to the medical treatment given.

In 18 of the 41 cases we used the fast or turbo intra-operative PTH with reduction of more than 60 % in all patients. In the group in whom normal PTH was performed, we registered 2 secondary hyperparathyroidisms with no significant decrease and persistence of symptoms. One of them was reoperated successfully.

Subtotal or total parathyroidectomy with reimplant represents the treatment of choice in refractory hyperparathyroidism with good results in most of the series reviewed.