Abstract: 0bjective To observe the clinical effect of parathyroidectomy (PTX) combined with autograft in forearm in end-stage renal disease (ESRD) patient complicated with refractory secondary hyperthyroidism (SHPT). Methods We retrospectively reviewed 15 MHD patients treated with PTX during the period from Apr. 2014 to Oct. 20l5. Symptoms before and after operation, operation complications, pathological findings of the surgical samples, biochemical parameters, serum iPTH, recurrence of SHPT, and prognosis were analyzed. Results Total PTX was successfully performed in 14 of the 15 cases (93.3%), and one patients with ectopic parathyroid in mediastinum failed to total removal of the gland. No patient died after the operation. SHPT recurred in one patient after 6 months (7.14%). In the 14 patients after total PTX for 6 months, serum iPTH decreased from 2017.21±561.52 ng/L to 122.47±78.74 ng/L (t=-6.460, P＜0.001), serum phosphorus decreased from 2.37 ± 0.70 mmol/L to 1.41 ± 0.98 mmol/L (t=- 2.172, P=0.045), serum calcium changed insignificantly from 2.51±0.25 mmol/L to 2.34±0.27 mmol/L (t=-1.246, P=0.231), ALP decreased from 534.61 ± 321.12 IU/L to 205.32 ± 134.63 IU/L (t=- 2.443, P=0.034), hemoglobin increased from 108 ±21.62 g/L to 118.8±9.98 g/L (t=0.951, P=0.046), ALB increased from 38.01±5.83 g/L to 40.25±3.45 g/L (t=1.02, P=0.042), bone pain and itching alleviated or disappeared, and the SF- 36 score for quality of life increased from 80.91±15.62 to 120.85±25.50 (t=-0.737, P=0.047). Conclusions PTX is a relatively safe and effective method for the treatment of MHD patients with SHPT. PTX can significantly improve biochemical indices, bone pain, itching and quality of life. Total PTX and autograft of a part of the surgical tissue in forearm is an important measure to prevent the recurrence of SHPT.

Key words: Hyperparathyroidism, Parathyroidectomy, Uremia