The role of parathyroidectomy in the management of secondary hyperparathyroidism

Purpose of review: Parathyroidectomy (PTX) is often used to treat severe secondary hyperparathyroidism (SHPT) in patients receiving maintenance dialysis. However, most evidence for the proposed benefits of PTX originates from observational studies, which cannot demonstrate causality. A reconsideration of the potential role of PTX might help guide its appropriate use. Recent findings: Several large observational studies have suggested that PTX can reduce mortality risk. However, these studies generally suffer from bias and confounding, tempering conclusions and suggesting that the true effects of PTX may not be known. PTX has been reported to be associated with a 2% 30-day mortality, a substantial risk for what is generally an elective procedure. Additionally, biochemical control after PTX in a subset of patients may be suboptimal. The optimal surgical approach to PTX in specific clinical scenarios is also uncertain. Summary: PTX may be beneficial for certain patients with severe SHPT and clinical symptoms, but identifying patients in whom the benefits are likely to outweigh the risks is a substantial challenge. Further, great care must be taken to monitor symptoms and laboratory values in patients who undergo PTX in the immediate postoperative period and, in many cases, well beyond.

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