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[Surgical treatment of secondary hyperparathyroidism in patients treated with renal replacement].

Between January 1990 and July 1997, in 15 maintenance dialyzed patients and in 3 patients after renal transplantation manifesting hyperparathyroidisms surgical treatment was performed. The diagnosis was based both on the estimation of serum PTH level, total and ionised calcium, phosphates, alkaline phosphatase and imaging procedures: ultrasonography and 99-mTc subtraction scintigraphy. Indications to surgical treatment included ailments like generalized prurigo, bone and joint pains and muscular weakness with no response to pharmacological treatment. The commonly used procedure was subtotal parathyroidectomy (94%), its extent, however, was in each case determined during surgery, depending on the quantity and size of parathyroid glands found. In all cases the immediate intraoperative histopathological examination of the resected tissues was performed. In 10 patients resection of the thyroid gland tissues was carried out because of goiter (56%), among them in 1 case occult papillar carcinoma was found in histopathological examination. In the postoperative period 4 patients (22%) manifested transient hypocalcemia with good response to pharmacological treatment. Good results of surgical treatment reflected by both ailment relief and normalization of serum PTH and phosphates were obtained in 16 patients (89%). In 2 patients (11%) the ailments subsided but did not completely disappear. Surgical treatment of secondary hyperparathyroidism by subtotal parathyroidectomy is efficacious and entails a low risk of complications.