Complex surgical treatment of secondary hyperparathyroidism in a multi-speciality hospital: a clinical case

• David D. Dolidze
• Diana V. Slepuhova
• Serghei D. Covantsev
• Oksana M. Perfilieva
• Egor M. Glotov
• Sergei N. Nasonov

Abstract

According to international statistics, approximately 30–50% of patients with end stage chronic kidney disease have parathyroid hormone levels exceeding 300 pg/mL, which is called secondary hyperparathyroidism. The modern therapy has several limitations, which lead to the need for surgical correction. Here we present a comprehensive, original approach to the treatment of a patient with secondary hyperparathyroidism and ectopic parathyroid tissue in a multi-speciality hospital. The patient underwent videothoracoscopy, removal of a mass of the anterior mediastinum mass, subtotal parathyroidectomy with bilateral removal of paratracheal tissue, thymectomy, and transposition of a fragment of the lower left parathyroid gland on its own vascular pedicle into the pre-laryngeal muscles with the insertion of two titanium labels. Follow-up examination after 3 months demonstrated no relapse, the parathyroid hormone level was 26.54 pg/mL, within a normal range. The proposed combined surgical method allowed to achieve a stable clinical effect while performing a minimally invasive intervention on the parathyroid glands without disease recurrence.

Keywords:parathyroid hormone; parathyroid gland; secondary hyperparathyroidism

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