Parathyroidectomy in Chronic Renal Failure

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Abstract
Parathyroidectomy was carried out in 26 patients over a 14-yr period. Excellent results were obtained in patients with severe hyperparathyroidism. Vascular calcification, hypercalcemia and pruritus did not justify surgery unless associated with unequivocal hyperparathyroidism. Thirteen patients required i.v. Ca infusion for up to 2 wk to control postoperative hypocalcemia. Ca requirements could be predicted from the preoperative plasma alkaline phosphatase level. Following operation, continued treatment with vitamin D was necessary to prevent hypocalcemia. Hyperparathyroidism recurred in 1 patient after 8 yr and 4 patients developed osteomalacia. Since parathyroid hormone may have toxic effects other than those on bone, maintenance of normal levels should be a long-term objective in the treatment of patients with chronic renal failure. Where large parathyroid glands are present, surgical reduction in gland mass is a logical prelude to long-term suppression of parathyroid hormone with vitamin D and phosphate-binding agents.