title: Outcomes of parathyroidectomy in renal hyperparathyroidism in patients with No access to renal transplantation in Singapore.
abstract: BACKGROUND
  Total parathyroidectomy with autotransplantation (TPTX + AT) and subtotal parathyroidectomy (SPTX) are considered standard surgical treatments for refractory renal hyperparathyroidism. However, there is little data available comparing their outcomes in an area with poor access to renal transplant and calcimimetics.
  
  
  METHODS
  Patients with renal hyperparathyroidism who underwent TPTX + AT and SPTX in a tertiary institution from 2006 to 2013 were studied. Patient characteristics, pre- and post-operative biochemical marker levels, and outcomes including recurrence rates, post-operative morbidity and mortality were analysed.
  
  
  RESULTS
  87 patients underwent parathyroidectomy for renal hyperthyroidism. Transplant patients were excluded in this study. 81 patients were on long-term dialysis, with a median time of 7 years from initiation of haemodialysis to parathyroidectomy. 57 patients (70.4%) underwent TPTX + AT while 24 (29.6%) underwent SPTX. Post-operatively, there was significant decrease in parathyroid hormone (PTH), calcium and phosphate levels in both groups. PTH and phosphate levels were significantly lowered with TPTX compared to SPTX (p = 0.004, 0.003). Symptomatic hypocalcaemia was seen in both groups. In a median follow-up of 4 years, 11 patients developed biochemical recurrence, with a median time of 29 months to recurrence. Median PTH at recurrence was 67.1 pmol/L. Rate of recurrence was higher in patients who underwent SPTX (20.8% vs 10.5%), with a shorter median time to recurrence (median 62.1 vs 81.3 months). 2 patients required resection of the autograft. Cohort mortality was 11 patients (13.4%), with 3 deaths secondary to cardiovascular events.
  
  
  CONCLUSIONS
  Total parathyroidectomy with autoimplantation is superior to subtotal parathyroidectomy in the short to intermediate term.
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore.
authors.forename: Parameswaran
authors.initials: P
authors.lastname: Rajeev
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore.
authors.forename: Kai Yin
authors.initials: KY
authors.lastname: Lee
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore.
authors.forename: Xin Jie
authors.initials: XJ
authors.lastname: Tang
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore.
authors.forename: Tiong Thye
authors.initials: TT
authors.lastname: Goo
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore.
authors.forename: Wee Boon
authors.initials: WB
authors.lastname: Tan
authors.affiliation: Endocrine Surgical Unit, Department of Surgery, University Surgical Cluster, BNational University Hospital, Singapore. Electronic address: kee_yuan_ngiam@nuhs.edu.sg.
authors.forename: Kee Yuan
authors.initials: KY
authors.lastname: Ngiam
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002118:Calcium / Q000097:blood; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood / Q000601:surgery*; D006996:Hypocalcemia / Q000209:etiology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D010280:Parathyroid Glands / Q000637:transplantation*; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy / Q000009:adverse effects* / Q000379:methods*; D010710:Phosphates / Q000097:blood; D011184:Postoperative Period; D011446:Prospective Studies; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D012846:Singapore; D013997:Time Factors; D014182:Transplantation, Autologous; D019737:Transplants; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone; D010710:Phosphates; D002118:Calcium
keywords: Hyperparathyroidism; Renal; Secondary; Surgery