1. Total Parathyroidectomy with
Auto-transplantation and thymectomy
in ESRD patients
New Mansoura General Hospital (International)
experience
DDrr.. OOssaammaa EEll--SShhaahhaatt
Consultant Nephrologist
Head of Nephrology Department
(New Mansoura General Hospital (international
(Egypt)

2. ::IInnttrroodduuccttiioonn
 Secondary hyperparathyroidism (2HPT) is a
common complication in hemodialysis patients.
 The majority of patients with 2HPT can be
managed by medical treatment with vitamin D
sterols and calcimimetics.
 In severe cases of 2HPT, medical therapy alone
may be ineffective.
 Some patients require surgical treatment in the
form of parathyroidectomy (PTX)
.Coulston JE, e tal. Br J Surg. 2010 Nov;97(11):1674-9

3. PPrroottooccooll
ooff ppaarraatthhyyrrooiiddeeccttoommyy
ffoorr ppaattiieennttss wwiitthh EESSRRDD

4. PPaattiieennttss SSeelleeccttiioonn ::
 Patients with PTH more than 1500 pg .
 Not responding to medical treatment.
Has no history of surgery in the neck
specially parathyroidectomy.

5. ::PPrreeooppeerraattiivvee
 Labs. including CBC, LFT, KFT, INR, S. k, S.
Na & S. Po4 and S.Ca.
 ENT & anesthesia consultation.
 Heparin free HD session the day before the
surgery.

6. ::IInnttrraaooppeerraattiivvee
Insertion of CVP .
 2 amp. Of ca gluconate diluted in 50cc
0.9% Nacl over 1 hour during the
surgery .

7. ::PPoossttooppeerraattiivvee
- Check S.ca & phosphorus on return from
theatre then every 6 h. till for 2 days then
every 12 h. for 3 days then daily .
IV Ca infusion which , changing the dose
according to S.Ca level .
Send the removed glands for
histopathological examination.
Check PTH 1 week after the operation .

8. FFoollllooww UUpp iinn OOuutt ppaattiieenntt cclliinniicc::
FFrreeqquueennccyy:
Weekly in the 1st month,
every 2 weeks in the 2nd & 3rd months&
then monthly.
RReeqquuiirreedd llaabb.:
Monthly PTH in first 3 months then every 3 months
Weekly S.Ca & S. phosphorus.
MMeeddiiccaattiioonnss:
Adjust to results .

10. OObbjjeeccttiivveess
 To present our experience in total
parathyroidectomy with auto-transplantation
of parathyroid gland and
thymectomy.

11. ::PPaattiieennttss&& mmeetthhooddss
Retrospective review of 2288ccaasseess underwent total
parathyroidectomy, thymectomy and auto-transplantation
performed over one year period.
Patients were selected based on symptoms of CKD-MBD
with intact PPTTHH level of 11550000 ppgg//mmll and
above. No preoperative imaging was required due to
lack of acceptable sensitivity in multi-gland disease. 44
ggllaannddss eexxcciissiioonn wwaass ppeerrffoorrmmeedd. Tiny portions of
a relatively healthy gland (equivalent to size of normal
gland) were aauuttoo--ttrraannssppllaanntteedd into sternomastoid
muscle pouches.

12. CClliinniiccaall ddaattaa
(Age, years (range 4444..55 (30-60)
RRT at time of surgery HHDD
(Duration of dialysis, years(range 88..77 (3 – 19 )

13. SS.. PPTTHH

14. SS.. CCaa

15. PPoosstt ooppeerraattiivvee SS.. CCaa

16. SS.. PPoo44

17. RReessuullttss
28 patients had curative surgery with the
mean postoperative PTH 95.9 pg/ml. Two
patients had persistent hyperparathyroidism
where one or 2 glands were not found in the
neck. One patient had recurrence , No
surgical complications were reported.

18. ::CCoonncclluussiioonn
Our data demonstrates encouraging
results in the treatment of this
disabling disease.
Preoperative localization is not
essential except in redo cases where
the sensitivity of various imaging
modalities is much better.

19. MMuullttiiddiisscciipplliinnaarryy TTeeaamm