Pekkolay Z, Aydin E, Kilinç F (2018) Clinical Outcomes of Parathyroidectomy in Resistant Renal Hyperparathyroidism. Int Arch Intern Med 2:005.


© 2018 Zafer Pekkolay, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

RESEARCH ARTICLE | OPEN ACCESSDOI: 10.23937/iaim-2017/1710005

Clinical Outcomes of Parathyroidectomy in Resistant Renal Hyperparathyroidism

Zafer Pekkolay1*, Emre Aydin2and Faruk Kilinç3

1Internal Medicine-Endocrinology Department, Dicle University, Diyarbakir, Turkey

2Internal Medicine-Nephrology Department, Dicle University, Diyarbakir, Turkey

3Internal Medicine-Endocrinology Department, Firat University, Elazig, Turkey



Secondary hyperparathyroidism is associated with impaired calcium, phosphorus and vitamin D balance in patients with chronic renal insufficiency, and patients are often treated medically. However, some patients have medical treatment resistance. The definition of resistant renal hyperparathyroidism despite intake of calcimimetic, parathormon binding and vitamin D analogs persistent parathormone elevation and related symptoms. The only treatment for resistant renal hyperparathyroidism is surgery. This study was designed to investigate the indications for operation of patients with parathyroidectomy due to resistant renal hyperparathyroidism.

Materials and methods

Nineteen patients over 18 years of age who underwent hemodialysis due to end stage renal failure and who underwent parathyroidectomy due to secondary and tertiary hyperparathyroidism were included in the study. Patients pre- and post-operative and most recent calcium, phosphorus, parathormon values, operative patterns, pathology reports were recorded. Clinical results of parathyroidectomy were discussed.


The study was designed with 19 patients. Eleven of the patients were female (57.9%), 8 were male (42.1%) and the mean age was 44 ± 19 (18-91) years. Preoperative parathormon: 1811 ± 901 (436-3513) pg/ml, 3 patients (15.8%) tertiary hyperparathyroidism; Sixteen patients (84.2%) were diagnosed with secondary hyperparathyroidism. Subtotal parathyroidectomy in 11 patients (57.9%), and recurrent disease in 3 patients (15.8%). Minimally invasive surgery was performed in 5 patients (26.3%). Three patients had persistent hypoparathyroidism (15.8%). The most frequent operation indication was a very high parathormon value (18/19: 94.7%). Surgical success rate was 68.4%. In patients, the most common symptom was bone and muscle pain (84.2%).


In our series, the most common surgical causes for medical treatment-resistant renal hyperparathyroidism were parathormon elevated and bone-muscle pain.