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Background <p>Comparative studies of total parathyroidectomy (TPTX) and total parathyroidectomy with autotransplantation (TPTX + AT) have primarily emphasized biochemical control and recurrence, whereas longitudinal outpatient oral calcium requirements have been less frequently quantified. This study compared short-term biochemical outcomes and postoperative calcium supplementation burden after these two procedures for refractory secondary hyperparathyroidism (SHPT).</p> Methods <p>We retrospectively analyzed a nonrandomized cohort of 80 patients with refractory SHPT who underwent parathyroidectomy between January and December 2021 (TPTX, <i>n</i> = 40; TPTX + AT, <i>n</i> = 40). Biochemical markers were evaluated preoperatively and at postoperative day 3 and at postoperative months 1, 3, and 6. The practical postoperative outcome was prescribed oral calcium carbonate burden (500-mg tablets/day) at discharge and at 3 and 6 months. Acute intravenous calcium use and calcitriol supplementation were also recorded.</p> Results <p>Both groups achieved satisfactory short-term biochemical control without major perioperative complications. Operative time was longer in the TPTX + AT group (<i>p</i> = 0.015). Compared with the TPTX + AT group, the TPTX group had higher serum calcium at 3 and 6 months, lower phosphate at 1 and 3 months, and lower bone-specific alkaline phosphatase and intact parathyroid hormone at 3 and 6 months. Despite these biochemical differences, acute intravenous calcium use and outpatient oral calcium and calcitriol supplementation did not differ significantly between groups.</p> Conclusions <p>TPTX and TPTX + AT yielded satisfactory short-term biochemical outcomes. TPTX + AT was associated with higher postoperative intact parathyroid hormone levels, compatible with greater postoperative parathyroid activity; however, no significant between-group difference in prescribed oral calcium or calcitriol supplementation burden through 6 months was detected. Because procedure allocation was nonrandomized, thymectomy practices differed, and follow-up was limited to 6 months, these findings are descriptive and do not establish procedural superiority or long-term recurrence risk.</p>

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Total parathyroidectomy versus total parathyroidectomy with autotransplantation for refractory secondary hyperparathyroidism: short-term biochemical outcomes and postoperative calcium supplementation burden

  • 期刊论文

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  • 发表日期：

    2026年7月21日

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  • Horng-Shiuan See,
  • Kian-Hwee Chong,
  • Yu-Tien Chen,
  • Jia-Hui Chen,
  • Chieh-Wen Lai

摘要

Background

Comparative studies of total parathyroidectomy (TPTX) and total parathyroidectomy with autotransplantation (TPTX + AT) have primarily emphasized biochemical control and recurrence, whereas longitudinal outpatient oral calcium requirements have been less frequently quantified. This study compared short-term biochemical outcomes and postoperative calcium supplementation burden after these two procedures for refractory secondary hyperparathyroidism (SHPT).

Methods

We retrospectively analyzed a nonrandomized cohort of 80 patients with refractory SHPT who underwent parathyroidectomy between January and December 2021 (TPTX, n = 40; TPTX + AT, n = 40). Biochemical markers were evaluated preoperatively and at postoperative day 3 and at postoperative months 1, 3, and 6. The practical postoperative outcome was prescribed oral calcium carbonate burden (500-mg tablets/day) at discharge and at 3 and 6 months. Acute intravenous calcium use and calcitriol supplementation were also recorded.

Results

Both groups achieved satisfactory short-term biochemical control without major perioperative complications. Operative time was longer in the TPTX + AT group (p = 0.015). Compared with the TPTX + AT group, the TPTX group had higher serum calcium at 3 and 6 months, lower phosphate at 1 and 3 months, and lower bone-specific alkaline phosphatase and intact parathyroid hormone at 3 and 6 months. Despite these biochemical differences, acute intravenous calcium use and outpatient oral calcium and calcitriol supplementation did not differ significantly between groups.

Conclusions

TPTX and TPTX + AT yielded satisfactory short-term biochemical outcomes. TPTX + AT was associated with higher postoperative intact parathyroid hormone levels, compatible with greater postoperative parathyroid activity; however, no significant between-group difference in prescribed oral calcium or calcitriol supplementation burden through 6 months was detected. Because procedure allocation was nonrandomized, thymectomy practices differed, and follow-up was limited to 6 months, these findings are descriptive and do not establish procedural superiority or long-term recurrence risk.