Management of patients with secondary and tertiary hyperparathyroidism referred to surgical treatment

Aim of the study was present personal observations connected with the management of patients referred to surgical treatment for secondary hyperparathyroidism (SHT) or tertiary hyperparathyroidism (THT), and to assess immediate results of such management.

A total of 175 patients aged 21-80 years were treated surgically for SHT, and 16 patients aged 36-64 years were treated surgically for THT, between 1 January 1996 and 31 December 2008. The patients were classified for surgical treatment in cooperation with a nephrologist, internist, and anaesthesiologist. Each patient underwent bilateral exploration of the neck and assessment of all identified parathyroid glands. Subtotal parathyroidectomy or resection of parathyroid glands combined with autotransplantation (the latter in two patients with recurrent SHT) were performed. Ionized calcium concentration in blood serum, water-electrolyte equilibrium, and cardiovascular system were monitored postoperatively.

A fall in ionized calcium levels was obtained postoperatively in all patients. Successful surgical treatment was confirmed by intraoperative macroscopic and immunochemical examinations. Intensive bleeding from the wound was noted in 2 (1%) patients, and intensified stenocardial symptoms in 15 (7.9%) patients with SHT. No deaths were noted during the perioperative period. Five (2.8%) patients with SHT required emergency dialyses.

1. Surgical treatment of secondary or tertiary hyperparathyroidism requires close cooperation between the surgeon, nephrologist, internist, and anaesthesiologist. 2. Successful results of the treatment, including minimum cardiovascular complications, can only be obtained in integrated cooperation with a dialysis centre.