Total parathyroidectomy and autotransplantation of parathyroid tissue for secondary hyperparathyroidism

Total parathyroidectomy and autotransplantation of parathyroid tissue were performed in ten hemodialysis patients. During the preoperative period, bone pain appeared in all patients, pruritus in 4, calcaneus fracture, rib fracture and Achilles tendon rupture in one respectively, and clubbed fingers in 4. Salt and pepper appearance of the skull x-ray and subperiosteal resorption in hand x-ray appeared in all patients. Preoperatively the averaged serum calcium (Ca) was 5.1mEq/l, phosphorus (P) 4.8mg/dl, alkaline phosphatase (ALP) 53.0KA units and PTH 38.3ng/ml. The parathyroid glands of all patients were visualized by computed tomography (CT) and/or scintigraphy with 201TICI and 99mTcO4-. Total parathyroidectomy and autotransplantation of parathyroid tissue were performed in all patients by Wells' method, and they were followed up from 3 to 16 months (mean, 10 months). Four or more glands were removed in 9 out of ten patients. Only one gland was removed in one patient. Excised parathyroid tissues were immediately autografted into a forearm muscle. The removed parathyroid glands weighed from 787 to 8, 100mg/patient (mean 3, 819mg/patient). The weight of the removed parathyroid glands was significantly correlated with the preoperative PTH level (r=0.706, p