Diagnosis of hyperparathyroidism with US after autotransplantation: results of a prospective study

The best treatment for reactive hyperparathyroidism, a complication of chronic renal failure, consists of resection of all four parathyroid glands and subsequent autotransplantation of parathyroid fragments into the brachioradialis muscle of the forearm. These procedures normalize the elevated parathyroid metabolism in at least two-thirds of the patients. In this prospective study, the parathyroid transplant was examined at least once with ultrasound (US) during postoperative follow-up for a maximum of 84 months in 22 women and 13 men who were undergoing long-term hemodialysis for reactive hyperparathyroidism. In 32 of these 35 patients, the graft-bearing forearm had a normal appearance on US scans. Three patients had one or two hypoechoic lesions 5-11 mm in diameter. Graft-dependent recurrent hyperparathyroidism was verified in two of these patients by means of clinical, biochemical, and histologic examination. It is concluded that US is effective in the recognition and localization of graft-dependent recurrent hyperparathyroidism.