Indications for parathyroidectomy and extent of treatment for patients with secondary hyperparathyroidism

Some manifestations of secondary hyperparathyroidism affect most if not all patients with chronic renal failure and can affect many different organ systems. Proper medical treatment is essential and should be attempted before considering surgical intervention. The symptoms that most often resolve after parathyroidectomy include bone pain and intractable pruritus. Other useful indications for operation include a marked elevation of the parathyroid hormone level and the elevation of the calcium x phosphate product over 70. Both subtotal parathyroidectomy and total parathyroidectomy with autotransplantation have been advocated as the best operative approach. Each of these procedures has its own advantages and disadvantages which should be considered for each individual case. Localizing procedures should be reserved for patients with persistent or recurrent hyperparathyroidism, as diffuse parathyroid hyperplasia is the most common operative finding in secondary hyperparathyroidism.