Total parathyroidectomy with auto-transplantation was performed on 22 patients with end-stage renal disease and hyperparathyroidism. All four parathyroid glands were removed and small portions of one gland were reimplanted in the neck. Post-operatively, 28 patients had normal parathyroid hormone levels, showing the surgery was curative. Two patients had persistent hyperparathyroidism where glands were not found. The procedure showed encouraging results in treating hyperparathyroidism complications in patients with kidney failure.

1. Total Parathyroidectomy with
Auto-transplantation and thymectomy
in ESRD patients
New Mansoura General Hospital (International)
experience
DDrr.. OOssaammaa EEll--SShhaahhaatt
Consultant Nephrologist
Head of Nephrology Department
(New Mansoura General Hospital (international
(Egypt)

2. ::IInnttrroodduuccttiioonn
 Secondary hyperparathyroidism (2HPT) is a
common complication in hemodialysis patients.
 The majority of patients with 2HPT can be
managed by medical treatment with vitamin D
sterols and calcimimetics.
 In severe cases of 2HPT, medical therapy alone
may be ineffective.
 Some patients require surgical treatment in the
form of parathyroidectomy (PTX)
.Coulston JE, e tal. Br J Surg. 2010 Nov;97(11):1674-9

3. PPrroottooccooll
ooff ppaarraatthhyyrrooiiddeeccttoommyy
ffoorr ppaattiieennttss wwiitthh EESSRRDD

4. PPaattiieennttss SSeelleeccttiioonn ::
 Patients with PTH more than 1500 pg .
 Not responding to medical treatment.
Has no history of surgery in the neck
specially parathyroidectomy.

5. ::PPrreeooppeerraattiivvee
 Labs. including CBC, LFT, KFT, INR, S. k, S.
Na & S. Po4 and S.Ca.
 ENT & anesthesia consultation.
 Heparin free HD session the day before the
surgery.

6. ::IInnttrraaooppeerraattiivvee
Insertion of CVP .
 2 amp. Of ca gluconate diluted in 50cc
0.9% Nacl over 1 hour during the
surgery .

7. ::PPoossttooppeerraattiivvee
- Check S.ca & phosphorus on return from
theatre then every 6 h. till for 2 days then
every 12 h. for 3 days then daily .
IV Ca infusion which , changing the dose
according to S.Ca level .
Send the removed glands for
histopathological examination.
Check PTH 1 week after the operation .

8. FFoollllooww UUpp iinn OOuutt ppaattiieenntt cclliinniicc::
FFrreeqquueennccyy:
Weekly in the 1st month,
every 2 weeks in the 2nd & 3rd months&
then monthly.
RReeqquuiirreedd llaabb.:
Monthly PTH in first 3 months then every 3 months
Weekly S.Ca & S. phosphorus.
MMeeddiiccaattiioonnss:
Adjust to results .

10. OObbjjeeccttiivveess
 To present our experience in total
parathyroidectomy with auto-transplantation
of parathyroid gland and
thymectomy.

11. ::PPaattiieennttss&& mmeetthhooddss
Retrospective review of 2288ccaasseess underwent total
parathyroidectomy, thymectomy and auto-transplantation
performed over one year period.
Patients were selected based on symptoms of CKD-MBD
with intact PPTTHH level of 11550000 ppgg//mmll and
above. No preoperative imaging was required due to
lack of acceptable sensitivity in multi-gland disease. 44
ggllaannddss eexxcciissiioonn wwaass ppeerrffoorrmmeedd. Tiny portions of
a relatively healthy gland (equivalent to size of normal
gland) were aauuttoo--ttrraannssppllaanntteedd into sternomastoid
muscle pouches.

12. CClliinniiccaall ddaattaa
(Age, years (range 4444..55 (30-60)
RRT at time of surgery HHDD
(Duration of dialysis, years(range 88..77 (3 – 19 )

13. SS.. PPTTHH

14. SS.. CCaa

15. PPoosstt ooppeerraattiivvee SS.. CCaa

16. SS.. PPoo44

17. RReessuullttss
28 patients had curative surgery with the
mean postoperative PTH 95.9 pg/ml. Two
patients had persistent hyperparathyroidism
where one or 2 glands were not found in the
neck. One patient had recurrence , No
surgical complications were reported.

18. ::CCoonncclluussiioonn
Our data demonstrates encouraging
results in the treatment of this
disabling disease.
Preoperative localization is not
essential except in redo cases where
the sensitivity of various imaging
modalities is much better.

19. MMuullttiiddiisscciipplliinnaarryy TTeeaamm