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Tam-Lin Chow, FRCS(Edin); Tony Tung-Fei Chan, FRCS(Edin); Yiu-Wing Ho, FRCP; Siu-Ho Lam, FRCS(Glasg)

Arch Surg. 2007;142(7):644-648.

Hypothesis  Most patients undergoing long-term dialysis are anemic because of underproduction of erythropoietin and its inhibition by high parathyroid hormone levels due to secondary hyperparathyroidism. Renal anemia can be improved by parathyroidectomy.

Design  Retrospective cohort study.

Setting  Regional hospital.

Patients  Twenty-three Chinese patients without a previous functioning renal transplant underwent parathyroidectomy for severe secondary hyperparathyroidism in a 3-year period.

Intervention  Total parathyroidectomy with or without parathyroid autograft at the forearm.

Main Outcome Measures  The preoperative and 6-month postoperative hematological and biochemical variables were compared for any differences by means of a paired t test.

Results  The mean ± SD follow-up duration was 17.7 ± 8.1 (range, 6-34) months. Three patients (13%) developed persistent or recurrent hyperparathyroidism and 2 patients (9%) were biochemically hypoparathyroid. The other 18 patients (78%) were euparathyroid. Surgical morbidity was minimal; only 1 patient had complications, consisting of a postoperative fever of unknown origin that resolved with conservative treatment. The mean ± SD hemoglobin level (8.6 ± 2.1 vs 9.4 ± 2.1 g/dL) but not the mean platelet level was significantly (P = .04) increased 6 months postoperatively. Likewise, the following other mean ± SD biochemical values improved after surgery: parathyroid hormone (2235 ± 500 vs 151 ± 312 pg/mL; P<.001), alkaline phosphatase (645 ± 349 vs 123 ± 82 U/L; P<.001), calcium (10.8 ± 4.0 vs 9.3 ± 1.0 mg/dL; P<.001), phosphate (1.93 ± 0.73 vs 1.50 ± 0.51 mmol/L; P = .02), and albumin (3.5 ± 0.5 vs 3.8 ± 0.6 g/dL; P = .006).

Conclusions  Parathyroidectomy is highly effective to control secondary hyperparathyroidism with an exceedingly low complication rate. The hemoglobin level was significantly elevated 6 months postoperatively. The long-term effect warrants future trials.

Author Affiliations: Division of Head and Neck, Reconstructive, and Breast Surgery, Department of Surgery (Drs Chow, Chan, and Lam), and Division of Nephrology, Department of Medicine (Dr Ho), United Christian Hospital, Hong Kong.

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