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Secondary (SHPT) and tertiary (THPT) hyperparathyroidism are common in patients with advanced chronic kidney disease, end-stage kidney disease, and post-kidney transplant. While initial treatment of SHPT is medical with vitamin D analogues and calcimimetics, patients may benefit from parathyroidectomy. Parathyroidectomy is indicated for patients with SHPT who have disease-related, medically refractory symptoms, signs, or biochemical derangements or inability to tolerate or comply with medical therapy. In patients with tertiary hyperparathyroidism, serum calcium and parathyroid hormone (PTH) should normalize within 6 months posttransplant. Lack of resolution after 6 months should prompt patient referral for consideration of parathyroidectomy. Parathyroidectomy is the treatment of choice for patients with THPT when serum calcium and PTH levels fail to normalize, to optimize bone health, and for symptom improvement when compared to cinacalcet. Normalization of PTH is important for renal graft function. Parathyroidectomy is likely protective from renal graft failure.

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Indications for Parathyroidectomy in Secondary and Tertiary Hyperparathyroidism

  • 章节

  • 发表日期：

    2025年

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  • Olivia M. DeLozier,
  • Sophie Dream

摘要

Secondary (SHPT) and tertiary (THPT) hyperparathyroidism are common in patients with advanced chronic kidney disease, end-stage kidney disease, and post-kidney transplant. While initial treatment of SHPT is medical with vitamin D analogues and calcimimetics, patients may benefit from parathyroidectomy. Parathyroidectomy is indicated for patients with SHPT who have disease-related, medically refractory symptoms, signs, or biochemical derangements or inability to tolerate or comply with medical therapy. In patients with tertiary hyperparathyroidism, serum calcium and parathyroid hormone (PTH) should normalize within 6 months posttransplant. Lack of resolution after 6 months should prompt patient referral for consideration of parathyroidectomy. Parathyroidectomy is the treatment of choice for patients with THPT when serum calcium and PTH levels fail to normalize, to optimize bone health, and for symptom improvement when compared to cinacalcet. Normalization of PTH is important for renal graft function. Parathyroidectomy is likely protective from renal graft failure.