Abstract: 【Abstract】 Objective To review the efficacy of re-operation, traditional medication therapy, and new vitamin D (VD) analogue combined with phosphate binder on the recurrent and persistent hyperparathyroidism after total parathyroidectomy and forearm autotransplantation (tPTX+AT). Methods The uremic patients with recurrent (13 cases) and persistent (3 cases) hyperparathyroidism after tPTX+AT from May 2013 to May 2014 in our hospital were analyzed. The treatment of these patients included re-operation to excise residual parathyroid gland in neck or forearm autotransplanted gland (group A, 5 cases), traditional medication therapy (group B, 6 cases), and new VD analogue combined with phosphate binder (group C, 5 cases). The effects of the three therapies were compared. Results Serum iPTH decreased significantly in all of the three groups after the treatment (P＜0.05) with the decrease rate and amplitude greater in group C than in group B (P＜0.05); iPTH was unchanged in the 2 cases in group A because of the failure of re-operation. In group A, serum calcium decreased significantly after re-operation (P0.05). In group B, serum calcium and phosphate increased significantly after routine medication therapy (P<0.05). In group C after new VD analogue + phosphate binder therapy, serum calcium increased slightly but was still in the normal range, and changed insignificantly as compared to the level before the therapy (P<0.05); serum phosphate decreased (P<0.05); the four-dimension scores of physiological functions, physical pain, emotional function, and mental health were significantly higher than those in groups A and B (P<0.05). Conclusion The therapy for group C (new VD analogue + phosphate binder) was better than the therapies for group A (re-operation) and B (routine medication) in lowering iPTH, reducing the risks for hypercalcemia and hyperphosphatemia, and improving quality of life in patients with recurrent and persistent hyperparathyroidism after tPTX+AT.

Key words: hyperparathyroidism, parathyroidectomy (PTX), recurrence, uremia, VD (Vitamin D)