title: Surgical management of secondary hyperparathyroidism: how to effectively reduce recurrence at the time of primary surgery.
abstract: BACKGROUND
  Successful parathyroidectomy (PTX) often results in a dramatic drop in the parathyroid hormone (PTH) levels, relieves the patient from clinical symptoms, and reduces mortality. Although PTX is generally a successful treatment for progressive secondary hyperparathyroidism (SHPT) patients subjected to surgery, a significant proportion develops recurrent SHPT following PTX.
  
  
  CONCLUSIONS
  SHPT requiring PTX occurs more commonly in progressive chronic kidney disease and in long-term lithium therapy. Operative approaches include subtotal PTX, total PTX with or without autotransplantation, and possible thymectomy. Each approach has its proponents, advantages, and disadvantages. Although PTX offers the highest percentage cure for SHPT, compared to all other medical and surgical treatment, recurrent hyperparathyroidism can be observed in some patients dependent on follow-up time. A literature review and analysis of recent data regarding how to reduce recurrence of SHPT at the time of primary surgery was performed. The current literature and our own experience in the field have confirmed that pre-operative imaging, thymectomy, stereo magnifier, and surgical procedure may effectively reduce recurrence of SHPT at the time of primary surgery.
authors.affiliation: Department of Emergency Surgery, The First Affiliated Hospital Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China.
authors.forename: D
authors.initials: D
authors.lastname: Xu
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yin
authors.affiliation: Department of Emergency Surgery, The First Affiliated Hospital Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China. 913788817@qq.com.
authors.forename: L
authors.initials: L
authors.lastname: Hou
authors.affiliation: Department of General Surgery, The First Affiliated Hospital of Harbin Medical University, No. 23 Youzheng Street, Nangang District, Harbin, 150001, Heilongjiang Province, People's Republic of China. wenjiedai@126.com.
authors.forename: W
authors.initials: W
authors.lastname: Dai
mesh_terms: D019468:Disease Management; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000601:surgery*; D016105:Parathyroidectomy; D012008:Recurrence; D055502:Secondary Prevention
keywords: Hyperparathyroidism; Parathyroidectomy; Renal hyperparathyroidism; Secondary hyperparathyroidism; Thymectomy