Parathyroid surgery in chronic renal insufficiency. Subtotal parathyroidectomy versus total parathyroidectomy with autotransplantation to the forearm.

During the period 1970 to 1980 48 parathyroidectomies were performed in 46 patients with chronic renal insufficiency. Thirty patients underwent 31 subtotal parathyroidectomies and 17 patients underwent total parathyroidectomy with parathyroid autotransplantation to the forearm. Ten patients were on conservative renal treatment, 26 were on chronic haemodialysis and 12 had functioning kidney transplants at the time of parathyroid surgery. The indication for parathyroidectomy were clinical symptoms such as pruritus, bone and joint pain, neuromuscular disorders and radiological skeletal abnormalities pointing to hyperparathyroidism (HPT). Hypercalcaemia was present in 38 patients. The clinical symptoms and radiological findings were favourably affected by parathyroid surgery but vascular calcification was not affected by the operation in any of the patients. Normocalcaemia was achieved after surgery in all patients except one, who had residual parathyroid tissue in the neck. Vitamin D substitution was required in about 30% of the patients regardless of the type of operation that was performed. Recurrent HPT occurred in 9% with similar rates after both types of surgery. However, recurrence was more easily managed after a total parathyroidectomy with autotransplantation to the forearm than after a subtotal parathyroidectomy.