Endocrine Abstracts

Introduction: Tertiary hyperparathyroidism (THPT) develops for the patients with chronic kidney diseases undergoes program hemodialysis. THPT is seen in patients with long-term secondary hyperparathyroidism which eventually leads to hyperplasia of the parathyroid glands (PTG) then it leads to adenomatous transformation and autonomization of the PTG.

The purpose of the study is the choice of rational diagnostic and treatment algorithm for the patients with THPT.

Methods/design: From 2013 to 2015 years 38 patients (12 woman, 26 man) with THPT were operated. The age was from 34 to 81 years. 29 people (76.3%) were older than 50 years. We detected levels parathyroid hormone (PTH), ionized calcium and phosphorus. We did make sonography thyroid and parathyroid glands, scintigraphy and MRI neck.

Results: Primordial level ionized calcium was 1.10±0.3 mmol/l, level PTH – 946.3±352.8 pg/ml, phosphorus – 1.72±0.2 mmol/l.

During operations one adenoma was removed at eight patients, on two adenomas removed from six patients. 19 patients have removed three adenomas and five patients – five adenomas. A total of 102 adenomas were removed from 38 people. Repeated operations were conducted in eight cases. The diagnosis were confirmed by histological studies.

Of the 16 patients with multiple lesions of the PTG (3 or more) only in 11 cases with scintigraphy were found signs of one or two gland. Ultrasound detect parathyroid adenomas only in 70–75% cases. MRI identifies adenomas in 31 (96.9%) cases.

In time operation thyroid nodules were found at 15 (39.5%) patients. At five cases were make subtotal thyroidectomies, at 4 cases – hemithyroidectomies and at six cases – resections of thyroid.

PTH after operations decreased to 302.6±195.4 pg/ml, and a week later was within or below the normal reference values at 78.9% of patients.

Conclusion: Sonography and scintigraphy PTG were detect adenomas in 70–75% cases, because the MRI necessary became for the algorithm investigation. Concomitant lesions of the thyroid and parathyroid glands were observed in more than 1/3 of the cases. Patients with THPT have needs for the lifelong follow-up.