Total parathyroidectomy and autotransplantation by the subcutaneous injection technique in secondary hyperparathyroidism

Purpose. To prospectively assess the effectiveness of total parathyroidectomy and autotransplantation using a subcutaneous injection technique to treat secondary hyperparathyroidism. Methods. We used this method to treat 14 patients with secondary hyperparathyroidism. The short-term outcome, up to 16 months after surgery, was monitored by measuring calcium, inorganic phosphorus, intact parathyroid hormone (iPTH), and alkaline phosphatase levels. We considered a graft viable when the ratio of iPHT in antecubital venous blood from the grafted arm to that from the nongrafted arm exceeded 1.5. Results. Autografted parathyroid tissue was functional in 12 (85.7%) patients. An iPTH ratio ≥1.5 in the grafted arm relative to the nongrafted arm was observed from 2 weeks after surgery, peaking at 1 month. The grafted tissue continued to be biochemically functional 16 months after surgery in 12 patients. Conclusion. These findings suggest that total parathyroidectomy and forearm autotransplantation using the subcutaneous injection technique is a possible alternative to Wells' method for surgical treatment of secondary hyperparathyroidism.