Advancing Education, Research, and Quality of Care for the Head and Neck oncology patient.
Background: Parathyroidectomy (PTX) is the only definitive cure for tertiary hyperparathyroidism (tHPT), but normocalcemic THPT patients are often not referred for surgical intervention. This study aims to assess the impact of PTX in tHPT in normocalcemic patients.
Methods: A multi-center international study included tHPT patients who underwent PTX following renal transplant. A total of 3939 renal transplant recipients were screened for PTX history. Patients were categorized into normocalcemia and hypercalcemia groups, and outcomes including biochemical parameters were assessed.
Results: Among 91 THPT patients who underwent PTX, 34.1% had normocalcemia and 65.9% had hypercalcemia. The cohorts were similar in age, sex, and risk stratification.v The normocalcemia group had worse preoperative creatinine (6.10, IQR=2.8-8.8) and eGFR (9.0, IQR=6-19) compared to the hypercalcemia group (p<0.001). The normocalcemia group had higher phosphorus levels (4.3±1.4mg/dL), and higher median PTH (236.3, IQR=405.6-663 ng/L) compared to the hypercalcemic group (p<0.001). At one-year follow-up following PTX, both groups achieved similar serum calcium (9.1±0.9 vs. 9.2±1, p=0.741), phosphorus (3.5±1.1 vs. 3.3±0.8mg/dL, p=0.41), and PTH (19.8 vs. 39.2, p=0.35) levels. At 6-month follow-up, the normocalcemia group demonstrated significantly improved renal function (creatinine:1.30, eGFR:47.0). At one-year follow-up, both groups had similar creatinine levels (1.30 and 1.12, p=0.06). Notably, there were no differences in operative time or postoperative complications, including hypoparathyroidism, between the normocalcemia and hypercalcemia groups.
Conclusion: Patients with tHPT with normocalcemia following renal transplant, present with more advanced disease and achieved excellent outcomes following PTX. PTX demonstrated benefits for tHPT patients irrespective of their calcium status, suggesting reconsideration of surgical referral criteria in this population.