Persistence of secondary hyperparathyroidism after parathyroidectomy in a patient with chronic kidney disease: a case report

Abstract

This is a clinical case of surgical treatment of persistence of secondary hyperparathyroidism (SHPT) in a patient with chronic kidney disease after previous parathyroidectomy. Programmed hemodialysis started in 2014, and in 2016 SHPT was diagnosed. In November 2018, indications for surgical treatment were presented in one of the clinics. According to scintigraphy, an increase in the functional activity of all four parathyroid glands (PTG) was observed, according to ultrasound data, the localization of the right lower, left upper and lower PTG was established. Removal of 3x PTG was performed without revision of the thymus horns (11.2018), while in the postoperative period, an adequate decrease in parathyroid hormone was not observed. After additional examination, according to ultrasound, scintigraphy and computer tomography of the neck with intravenous enhancement, it was found that both lower PTGs are located in the upper horns of the thymus. In July 2020, a repeated surgical intervention was performed in the volume of the right lower and left lower parathyroidectomy with a positive intraoperative test. Remission of SHPT was achieved. At present, no consensus has been reached on the extent of surgery for SHPT, since no statistically significant differences were found in the incidence of persistence / recurrence of SHPT. A complete assessment of the results of preoperative imaging techniques is required when planning surgery. Intraoperative monitoring of parathyroid hormone is an effective technique for assessing the radicality of surgical treatment.