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Chemical Ablation of Recurrent and Persistent Secondary Hyperparathyroidism After Subtotal Parathyroidectomy

Chen, Han-Hsiang MD*,†; Lin, Cheng-Jui MD*,†,‡; Wu, Chih-Jen PhD*,†,§; Lai, Chuan-Tsai MD*; Lin, Jackson MD*; Cheng, Shin-Ping MD†,¶; Yang, Tseng-Long MD†,¶

doi: 10.1097/SLA.0b013e318211ccc2
Original Articles

Background: Despite preoperative localization or intraoperative parathyroid hormone, monitoring increased the operative successful rate, recurrent, and persistent secondary hyperparathyroidism are still unavoidable after parathyroidectomy or reoperation. We present our experience of using percutaneous ethanol injection therapy (PEIT) in treating these patients.

Purpose: To conduct a prospective study of 49 patients with recurrent and persistent hyperparathyroidism using PEIT after subtotal parathyroidectomy or reoperative failure.

Patients and Methods: From January 2001 to August 2009, 49 patients with recurrent or persistent 2HPT after subtotal parathyroidectomy received PEIT. All dialysis patients were divided into 2 groups: recurrent group (n = 28) and persistent group (n = 21). Before PEIT, every patient received sestamibi-(99m)Tc scintigraphy (MIBI scanning), neck ultrasonography (US), bone scanning (T-score and Z-score), and parathyroid function testing. We compared the responses to PEIT treatment in the recurrent and persistent groups with the following parameters: treatment success rate, improvement in bone density, concurrence in diagnosis between US and MIBI scanning and complications.

Results: Treatment success was defined as intact PTH < 300 pg/mL; recurrent group is 25 of 28 (89.3%) and persistent group is 20 of 21 (95.2%) (P = 0.694). There was no difference in success rate statistically. T-score in recurrent group before PEIT was −1.2 ± 0.9 and after treatment was −0.6 ± 0.6 (P = 0.004), which is statistically significant. In the persistent group, T-score before PEIT was −1.2 ± 1.0 and after treatment was −0.8 ± 0.6 (P = 0.101). There was no significant difference. For consistence between neck US and MIBI scanning were concordant in the recurrent group in 20 of 28 (71.4%); in persistent group, it was 14 of 21 (66.6%) (P = 0.245); there was no significant difference. Regarding the complications, only hypocalcemia was significantly more common in the recurrent group. Hypocalcemia occurred in 14 of 28 patients in the recurrent group and 6 of 21 in the persistent group (P = 0.022).

Conclusions: Regardless of which group patient was in, PEIT can achieve satisfying result when parathyroid masses were detected by US. Subtotal parathyroidectomy plus PEIT was probably the best combination for treatment of secondary hyperparathyroidism.

Despite preoperative localization or intraoperative parathyroid hormone monitoring increasing the operative success rate, recurrent and persistent secondary hyperparathyroidism (SHPT) are still unavoidable after parathyroidectomy or reoperation. We present our experience using percutaneous ethanol injection therapy (PEIT) in treating these patients. PEIT can achieve a satisfactory result when parathyroid masses are detected by US. Subtotal parathyroidectomy plus PEIT is perhaps the best combination for treatment of SHPT.

*Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.

Mackay Medicine, Nursing and Management College, Taipei, Taiwan.

Department of Nursing, College of Wellbeing Science and Technology, Yuanpei University, Taipei, Taiwan.

§Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan.

Department of General Surgery, Mackay Memorial Hospital, Taipei, Taiwan.

Reprints: Han-Hsiang Chen, MD, Division of nephrology, Department of Internal Medicine, Mackay Memorial Hospital, 92 Chung San North Road, Section 2, Taipei 104, Taiwan. E-mail: lincj@ms1.mmh.org.tw.

This study has no financial support.

The authors state that they do not have commercial sponsorship for this article.

© 2011 Lippincott Williams & Wilkins, Inc.