A Preoperative Parathyroid Scan is Important for the Total Removal of the Transplanted Parathyroid Tissue in Recurrent Secondary Hyperthyroidism: A Case Report and Literature Review

Overview

Journal Medicine (Baltimore)

Specialty General Medicine

Date 2023 Jan 3

PMID 36595874

Authors

Xin-Ling Guo

Wen-Yao Yin

Affiliations

Soon will be listed here.

Abstract

Rationale: Secondary hyperparathyroidism was one of mineral and bone disorders owing to chronic kidney disease. Patients who suffer from secondary hyperparathyroidism would receive medical treatment or parathyroidectomy with or without autotransplantation (AT). However, some patients receiving parathyroidectomy with AT have recurrent hyperparathyroidism, which impacts their lives. Patients with recurrent hyperparathyroidism may present persistent hypercalcemia and hyperphosphatemia, which would cause cardiovascular disease, like atherosclerosis.

Patient Concerns: A 63-year-old female of Asian descent with chronic kidney disease who suffered from recurrent hyperparathyroidism for twice. The patient underwent parathyroidectomy with AT in the left thigh when secondary hyperparathyroidism happened. After 3 months, recurrent hyperparathyroidism happened.

Diagnosis: The patient was diagnosed with recurrent hyperparathyroidism due to chronic kidney disease with hyperparathyroidism status post parathyroidectomy with AT in the left thigh. Our patient also suffered from mineral and bone disorder.

Intervention: Two parathyroid adenoma in the left thigh were found. However, one of them was too small to found in the operation. Therefore, autograftectomy of the large one was performed. However, hyperparathyroidism happened again. This time, the autograftectomy was performed under dual phase Tc-99m MIBI (99m Tc-methoxy isobutyl isonitrile) parathyroid scintigraphy and it succeeded.

Outcomes: After secondary autograftectomy, the value of intact parathyroid hormone was surveyed immediately and dropped by two-third followed by gradual reduction in the following weeks. The calcemia and phosphatemia were back to normal gradually.

Lessons: In our case, importance of scintigraphy in the parathyroidectomy was confirmed.

References

Zhou B, Zhu L, Xiang C, Cheng F, Zhu X, Zhou Y . Total parathyroidectomy with forearm autotransplantation in secondary hyperparathyroidism patients: analysis of muscle, subcutaneous and muscle + subcutaneous method. BMC Surg. 2021; 21(1):226. PMC: 8088620. DOI: 10.1186/s12893-021-01222-2. View

Steinl G, Kuo J . Surgical Management of Secondary Hyperparathyroidism. Kidney Int Rep. 2021; 6(2):254-264. PMC: 7879113. DOI: 10.1016/j.ekir.2020.11.023. View

Agha A, Loss M, Schlitt H, Scherer M . Recurrence of secondary hyperparathyroidism in patients after total parathyroidectomy with autotransplantation: technical and therapeutic aspects. Eur Arch Otorhinolaryngol. 2011; 269(5):1519-25. DOI: 10.1007/s00405-011-1776-7. View

. Erratum: Kidney Disease: Improving Global Outcomes (KDIGO) CKD-MBD Update Work Group. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder.... Kidney Int Suppl (2011). 2019; 7(3):e1. PMC: 6341011. DOI: 10.1016/j.kisu.2017.10.001. View

Kakani E, Sloan D, Sawaya B, El-Husseini A, Malluche H, Rao M . Long-term outcomes and management considerations after parathyroidectomy in the dialysis patient. Semin Dial. 2019; 32(6):541-552. DOI: 10.1111/sdi.12833. View

Steffen L, Moffa G, Muller P, Oertli D . Secondary hyperparathyroidism: recurrence after total parathyroidectomy with autotransplantation. Swiss Med Wkly. 2019; 149:w20160. DOI: 10.4414/smw.2019.20160. View

Chen Y, Liang B, Dong X, Huang T, Liu T . Diagnostic Accuracy of Intraoperative Intact Parathyroid Hormone Monitoring for Surgical Outcomes of Secondary Hyperparathyroidism. Med Sci Monit. 2021; 27:e932556. PMC: 8638211. DOI: 10.12659/MSM.932556. View

Yang J, Zhang J, Liu N, Liu H, Dong M . Persistent secondary hyperparathyroidism caused by parathyromatosis and supernumerary parathyroid glands in a patient on haemodialysis. BMC Nephrol. 2020; 21(1):257. PMC: 7339528. DOI: 10.1186/s12882-020-01917-3. View

Liu M, Qiu N, Zha S, Du Z, Wang Y, Wang Q . To assess the effects of parathyroidectomy (TPTX versus TPTX+AT) for Secondary Hyperparathyroidism in chronic renal failure: A Systematic Review and Meta-Analysis. Int J Surg. 2017; 44:353-362. DOI: 10.1016/j.ijsu.2017.06.029. View

10.

Hsu Y, Hung C . Intramuscular and subcutaneous forearm parathyroid autograft hyperplasia in renal dialysis patients: A retrospective cohort study. Surgery. 2015; 158(5):1331-8. DOI: 10.1016/j.surg.2015.04.027. View

11.

Zhang J, Dong M, Yang J, Tian D . Unusual recurrent renal secondary hyperparathyroidism caused by hyperplastic autograft with supernumerary parathyroid adenoma: A case report. Medicine (Baltimore). 2019; 98(24):e16077. PMC: 6587644. DOI: 10.1097/MD.0000000000016077. View