Replantation with cryopreserved parathyroid for permanent hypoparathyroidism: a case report and review of literatures.

Permanent postsurgical hypoparathyroidism is defined as insufficient parathyroid hormone (PTH) to maintain normocalcemia 6 months after surgery. It occurs mostly in reoperation for persistent or recurrent hyperparathyroidism. The treatment of long-term calcium and vitamin D supplement is burdensome and may cause iatrogenic complications. PTH replacement is potential but still under trials. Only replantation with cryopreserved parathyroid is an available treatment for patients to reduce or stop long-term drug administration. However, this treatment is not applied widely in developing countries, due to lack of experiences and skills. Herein, we reported a 58-year-old male presented a continuous elevated parathyroid hormone up to about 2342 ng/L and bone pain during hemodialysis for 6 years due to chronic renal failure. He underwent the first operation total parathyroidectomy and autotransplantation. After this operation, he suffered from a persistent calcemia and permanent hypoparathyroidism. After three times of replantation with cryopreserved parathyroid and dialysis with a high calcium dialysate, the low concentration of calcium was elevated and symptoms of hypocalcemia disappeared. However, PTH was not elevated significantly in the long term. It might be related to our nonstandard cryopreservation protocol and no microbiological and histological examinations before replantation, compared with other successful reports. Therefore, we suggest a standard cryopreservation protocol should be followed by non-experienced institutions, especially in developing countries. Furthermore, a high calcium dialysate is efficient to increase calcium concentration and alleviate symptoms of hypocalcemia. It may be an available treatment of persistent hypocalcemia and permanent hypoparathyroidism in dialysis patients.