Subtotal Parathyroidectomy: A Comprehensive Review for Secondary Hyperparathyroidism Management

Abstract

Secondary hyperparathyroidism (sHPT) is a common complication of chronic kidney disease (CKD), characterized by excessive secretion of parathyroid hormone (PTH) due to disrupted calcium-phosphate homeostasis. Subtotal parathyroidectomy (sPTx), involving the resection of 3.5 parathyroid glands, has emerged as an effective surgical option for patients with refractory sHPT, particularly when medical management fails. This review explores the role of sPTx in the management of sHPT, focusing on indications, surgical techniques, and outcomes. Evidence from recent studies highlights the procedure’s success in achieving durable biochemical control, alleviating clinical symptoms, and improving quality of life. The long-term benefits of sPTx are contrasted with potential complications, including persistent or recurrent hyperparathyroidism and hypoparathyroidism. Furthermore, this article addresses the evolving landscape of sHPT management, emphasizing the need for individualized treatment plans and interdisciplinary care. By synthesizing current research and clinical insights, this review aims to provide a comprehensive understanding of the efficacy and limitations of subtotal parathyroidectomy in managing secondary hyperparathyroidism, contributing to optimized patient care and surgical decision-making.