The aim of this study is to present clinical data from 200 patients surgically treated for secondary (renal) hyperparathyroidism and discuss optimal therapy and perioperative considerations.

This is a retrospective analysis of patient data collected between 2014 and 2016. We included 200 patients who were first time surgically treated for renal hyperparathyreoidism. We use descriptive statistics to characterize preoperative and postoperative variables in our cohort.

Preoperative diagnostic included sonography in most cases (91%) while 26% received mibi-scintigraphy additionally. Complications included temporary recurrent nerve palsy in 2% and postoperative bleeding in 1 % of all patients. In 57 % of patients subtotal resection (>3,5 resected glands) was performed (SPT). In 35 % of patients, less than 3,5 glands were resected (LSPT). 8 % of patients were treated by total parathyreoidectomy (TPT). The risk of persistence or relapse of hyperparathyroidism was 5 % in the SPT group and 21% in the LSPT group. None of the TPT patients showed recurrence. 31 % of the TPT patients suffered from Hypoparathyroidism. In 81% of SPT patients, we performed cryopreservation of parathyroid tissue. There were only two cases (2%) of re-implantation two years after the parathyreoidectomy and 5 further patients developed persistent hypoparathyroidism in the long run without retransplantation.

Subtotal Parathyroidectomy should be the therapy of choice for renal hyperparathyreoidism in an experienced center, due to the low rates of recurrence and the low rates of hypoparathyroidism. The need for cryopreservation should be discussed as in 98% of patients it showed no benefit.