Archives of Head and Neck Surgery
Archives of Head and Neck Surgery
Original Article Parathyroid diseases

Hypoparathyroidism after total parathyroidectomy with immediate autotransplantation or subtotal parathyroidectomy for hyperparathyroidism after renal transplantation

Felipe Ferraz Magnabosco, André Albuquerque Silveira, Marília D’Elboux Guimarães Brescia, Climério Pereira do Nascimento, Sérgio Samir Arap, Fábio Luiz de Menezes Montenegro

Downloads: 3
Views: 236


Introduction: Hypoparathyroidism is a nocuous complication. Parathyroidectomy (PTx) is the treatment of choice for persistent hyperparathyroidism after renal transplantation (HPT-RT). Objective: Analyze the postoperative hypoparathyroidism rate after total parathyroidectomy with immediate autotransplantation (PTxT+AT) and subtotal parathyroidectomy (PTxST), due to HPT-RT. Materials and Methods: Retrospective, cohort study of patients who underwent PTx due to HPT-RT between 2013 and 2018. The following serum parameters were analyzed before surgery, in the immediate postoperative period, and one and two years after surgery: total calcium (CaT), ionic calcium (Cai), phosphorus (P), parathormone (PTH), and creatinine; in addition, a search was conducted in the patients’ medical records to verify whether they received calcium and/or calcitriol oral supplementation at the same time intervals. Results: Thirty-eight patients underwent PTx (57.5% PTxT+AT; 42.5% PTxST). Mean CaT, Cai and P values and median PTH and creatinine values were similar. Significant difference was observed before and immediately after surgery for CaT, Cai, P, and PTH (p< 0.0001). There was also difference pre- and post-surgery for creatinine (p=0.0004 PTxT+AT; p=0.028 PTxST). The PTxST group needed less calcium supplementation (p=0.0003; p=0.01). One year after surgery, PTxT+AT and PTxST hypoparathyroidism rates were 61.9 and 11.8%, respectively (p=0.0025). Conclusion: There was similarity between the groups. Biochemical improvement was observed from the preoperative to the immediate postoperative periods in each group separately. One year after surgery, there was stability in calcium levels in both groups. Serum PTH and calcium levels tended to be higher in the PTxST group after two years. Both groups presented transient deterioration of renal function. The PTxST group needed less CaCO3 supplementation. Both techniques had satisfactory outcomes. More patients required calcium and calcitriol supplementation after PTxT+AT. The PTxST group presented a lower hypoparathyroidism rate.


hyperparathyroidism; parathyroidectomy; hypoparathyroidism; renal transplantation.


1. Magnabosco FF, Tavares MR, Montenegro FLM. Tratamento cirúrgico do hiperparatireoidismo secundário: revisão sistematizada da literatura. Arq Bras Endocrinol Metabol. 2014;58(5):562-71. PMid:25166048.

2. Ianhez LE. Transplante Renal. Seguimento a longo prazo. São Paulo. Lemos Editorial; 2002. p. 36-8.

3. Evenepoel P. Recovery versus persistence of disordered mineral metabolism in kidney transplant recipients. Semin Nephrol. 2013;33(2):191-203. PMid:23465505.

4. Lewin E. Involution of the parathyroid glands after renal transplantation. Curr Opin Nephrol Hypertens. 2003;12(4):363-71. PMid:12815332.

5. Triponez F, Clark OH, Vanrenthergem Y, Evenepoel P. Surgical treatment of persistent hyperparathyroidism after renal transplantation. Ann Surg. 2008;248(1):18-30. PMid:18580203.

6. Torres A, Lorenzo V, Salido E. Calcium metabolism and skeletal problems after transplantation. J Am Soc Nephrol. 2002;13(2):551-8. PMid:11805187.

7. Montenegro FLM. Paratireoidectomia total com autotransplante no tratamento do hiperparatireoidismo após transplante renal. [tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2014.

8. Datasus. [Internet]. [cited 2014 July 21]. Available from: http://aplicacao.Área_Especializada/relatorios_estatisticos/transplantes-realizados

9. Maass E, Mueller GA, Heller T, Koziolek MJ. Decrease in serum tacrolimus level and rise in serum creatinine under late addition of cinacalcet in a renal transplant recipient with hyperparathyroidism: a case report. Transplant Proc. 2007;39(10):3468-70. PMid:18089410.

10. Cintin C, Karstrup S, Ladefoged SD, Joffe P. Tertiary hyperparathyroidism treated by ultrasonically guided percutaneous fine-needle ethanol injection. Nephron. 1994;68(2):217-20. PMid:7830859.

11. Fletcher S, Kanagasundaram NS, Rayner HC, Irving HC, Fowler RC, Brownjohn AM, Turney JH, Will EJ, Davison AM. Assessment of ultrasound guided percutaneous ethanol injection and parathyroidectomy in patients with tertiary hyperparathyroidism. Nephrol Dial Transplant. 1998;13(12):3111-7. PMid:9870475.

12. de Barros Gueiros JE, Chammas MC, Gerhard R, da Silva Dias Boilesen CF, de Oliveira IR, Moysés RM, Jorgetti V. Percutaneous ethanol (PEIT) and calcitriol (PCIT) injection therapy are ineffective in treating severe secondary hyperparathyroidism. Nephrol Dial Transplant. 2004;19(3):657-63. PMid:14767023.

13. Lou I, Schneider DF, Leverson G, Foley D, Sippel R, Chen H. Parathyroidectomy is underused in patients with tertiary hyperparathyroidism after renal transplantation. Surgery. 2016;159(1):172-9. PMid:26603850.

14. Ferreira GF, Montenegro FL, Machado DJ, Ianhez LE, Nahas WC, David-Neto E. Parathyroidectomy after kidney transplantation: short- and long-term impact on renal function. Clinics (São Paulo). 2011;66(3):431-5. PMid:21552668.

15. Oliveira RB, Silva EN, Charpinel DMF, Gueiros JEB, Neves CL, Sampaio EA, Barreto FC, Karohl C, Ribeiro MC, Moysés RMA, Jorgetti V, Carvalho AB. Situação do hiperparatireoidismo secundário autônomo no Brasil: dados do censo brasileiro de paratireoidectomia. J Bras Nefrol. 2011;33(4):457-62. PMid:22189810.

16. Santos SRCL. Fatores preditivos da hipofunção do autoimplante de paratireoide em pacientes submetidos à paratireoidectomia total com autoimplante imediato por hiperparatireoidismo secundário à doença renal crônica. [tese]. São Paulo: Faculdade de Medicina, Universidade de São Paulo; 2012.

17. Ohe MN, Santos RO, Hojaij F, Neves MC, Kunii IS, Orlandi D, Valle L, Martins C, Janovsky C, Ferreira R, Delcelo R, Domingos AM, Abrahão M, Cervantes O, Lazaretti-Castro M, Vieira JG. Parathyroid carcinoma and hungry bone syndrome. Arq Bras Endocrinol Metabol. 2013;57(1):79-86. PMid:23440103.

18. Shoback DM, Bilezikian JP, Costa AG, Dempster D, Dralle H, Khan AA, Peacock M, Raffaelli M, Silva BC, Thakker RV, Vokes T, Bouillon R. Presentation of Hypoparathyroidism: Etiologies and Clinical Features. J Clin Endocrinol Metab. 2016;101(6):2300-12. PMid:26943721.

19. Shindo M, Lee JA, Lubitz CC, McCoy KL, Orloff LA, Tufano RP, Pasieka JL. The Changing Landscape of Primary, Secondary, and Tertiary Hyperparathyroidism: Highlights from the American College of Surgeons Panel, “What’s New for the Surgeon Caring for Patients with Hyperparathyroidism. J Am Coll Surg. 2016;222(6):1240-50. PMid:27107975.

20. Stack BC Jr, Bimston DN, Bodenner DL, Brett EM, Dralle H, Orloff LA, Pallota J, Snyder SK, Wong RJ, Randolph GW. American Association of Clinical Endocrinologists and American College of Endocrinology Disease State Clinical Review: postoperative hypoparathyroidism – definitions and management. Endocr Pract. 2015;21(6):674-85. PMid:26135962.

21. Florescu M, Plumb T, Smith-Shull S, Nieman J, Mandalapu P, Islam KM. Calcium supplementation after parathyroidectomy in dialysis and renal transplant patients. Int J Nephrol Renovasc Dis. 2014;7:183-90. PMid:24868170.

22. Jäger MD, Kaaden S, Emmanouilidis N, Lück R, Beckmann JH, Güner Z, Kespohl H, Glockzin K, Aselmann H, Kaudel CP, Schwarz A, Zapf A, Klempnauer J, Scheumann GF. Effect of incomplete parathyroidectomy preserving entire parathyroid glands on renal graft function. Arch Surg. 2011;146(6):704-10. PMid:21690447.

Submitted date:

Accepted date:

61731358a9539552413fce93 archives Articles
Links & Downloads

Arch. Head Neck Surg.

Share this page
Page Sections