Refractory Secondary Hyperparathyroidism in Chronic Renal Impairment: Is Surgery a Viable Option to Achieve a Biochemical Balance in Patients Failing Medical Management?

Secondary hyperparathyroidism (SHPT) is a common complication in chronic kidney disease patients, necessitating effective management to prevent adverse outcomes. This study evaluates the efficacy of surgical intervention in achieving biochemical balance in SHPT patients resistant to medical therapy. The study includes 36 patients with SHPT who underwent subtotal parathyroidectomy following failed medical management. Surgical outcomes, postoperative complications, and long-term follow-up data are analyzed. Of the total patients, 23 patients (63.9%) experienced symptomatic hypocalcaemia and 14 patients (38.9%) had hungry bone syndrome (HBS). The average time to calcium nadir in the post-op period was 75 hours (52-84 hours). The average length of the hospital stay was five days. A total of 5 patients (13.8%) had post-op nerve palsies. Our cohort had an initial cure rate of 91.6% with only 3 patients (8.3%) detected to have persistent hypercalcemia post-procedure. Even in the above, remnant or ectopic parathyroid glands were detected on follow-up imaging and subjected to re-surgery, which resulted in a cure. A statistically significant fall in mean PTH (< 0.0001) and Serum Calcium levels (< 0.01) was noted in the recruited patients at 36 months postsurgical intervention. Results indicate that restoration of biochemical balance in patients with SHPT refractory to medical therapy surgical measures mitigate the symptoms linked with SHPT, including bone discomfort, muscular weakness, and pervasive fatigue. Despite potential complications such as hypocalcaemia and nerve palsy, meticulous surgical techniques and postoperative care led to favourable outcomes in the study cohort. The study highlights the importance of surgical intervention as a viable option for achieving biochemical equilibrium in refractory SHPT patients with chronic renal impairment, ultimately improving their quality of life.