Abstract: 【Abstract】Objective To analyze the clinical characteristics of the 265 secondary hyperparathyroidism (SHPT) patients who underwent total parathyroidectomy (t-PTX). Methods Clinical manifestations, laboratory results and pathological changes of the SHPT patients who underwent t-PTX from January 2018 to December 2019 were retrospectively analyzed. Results In the 265 patients, the SHPT lasted 1-9 (3.07±2.13) years, 5 had heterotopic paraglands (1.89%), 220 had 4 paraglands removed (83.02%), 182 had nodular hyperplasia, 6 had adenomatous hyperplasia, and 64 had both types of hyperplasia. After operation, 218 patients
developed hypocalcemia (82.26%). During hospitalization, 557.86±376.20 ml of higher concentration calcium was supplemented intravenously. After operation, 6 patients recurred (22.64%), and 2 patients died in peri-operation period (0.75%). Before operation, serum PTH was 588～2934 (1729.15±345.18) pg/ml, Ca was 1.95～2.93 (2.43±0.19) mmol/L, and P was 1.3～3.59 (2.38±0.52) mmol/L; during operation, PTH decreased to 49.00～895.00 (286.97±179.25) pg/ml; after operation, PTH, CA and P levels decreased significantly (t=6.630, - 2.965 and - 3.412 respectively; P＜0.001, 0.005 and 0.001 respectively). Bone pain was
found in 246 patients (92.83%), with the bone pain course of 0~8 years (2.30±1.95) years and bone pain score of 0～10 (5.08 ± 2.65) points. Bone density measurement found normal bone mass in 34 patients (12.83%), lower bone mass in 105 patients (39.62%), and osteoporosis in 126 patients (47.55%). Skin itch was found in 197 patients (74.34%), with the itch course of 0~8 years (2.13±1.25) years and itch score of 0～10 (3.58±1.19) points. After operation 6 morrths, bone pain and itch improved significantly (t=7.897 and 2.542 respectively; P<0.001 and 0.014 respectively). Conclusions t-PTX is a safe and effective method to treat SHPT. Most SHPT patients have severe bone pain and itching. The pathological changes of parathyroids were mainly nodular lesions. SHPT can be significantly improved by t-PTX surgery. Severe hypocalcemia may occur after surgery, which should be carefully monitored.

Key words: Secondary hyperparathyroidism, Total parathyroidectomy, Clinical characteristic