TITLE:
Surgical Management of Medically Refractory Secondary Hyperparathyroidism: Operative Choices and Prevention of Persistent or Recurrent Disease
AUTHORS:
Junming Shi, Chuanchang Yin
KEYWORDS:
Secondary Hyperparathyroidism, Parathyroidectomy, Chronic Kidney Disease, Dialysis, Hungry Bone Syndrome, Recurrent Hyperparathyroidism
JOURNAL NAME:
Journal of Biosciences and Medicines,
Vol.14 No.10,
October
19,
2026
ABSTRACT: Parathyroidectomy is considered when secondary hyperparathyroidism (SHPT) remains poorly controlled despite tolerable medical treatment. In patients receiving long-term dialysis, the decision often follows progressive gland enlargement, persistent disturbances of mineral metabolism, or symptoms that no longer respond adequately to medication. This narrative review examines surgical referral, the choice of operation, and the management of disease that persists or recurs after surgery. Subtotal parathyroidectomy preserves a cervical remnant; total parathyroidectomy may be performed with or without autotransplantation. Each approach leaves a different risk of recurrent hyperparathyroidism and sustained loss of parathyroid function. The available evidence does not establish one procedure as preferable for every patient. Operative planning therefore requires consideration of transplantation prospects, bone disease, the feasibility of long-term supplementation, and access to follow-up. Particular attention is given to ectopic and supernumerary glands, interpretation of intraoperative parathyroid hormone, and postoperative hungry bone syndrome. Sampling and calcium-management pathways are described alongside proposed definitions of biochemical control, persistence, recurrence, and clinically meaningful chronic hypoparathyroidism. These definitions and pathways require local adaptation and prospective validation. The benefit of adjunctive cervical thymectomy or selective exploration of central-compartment fat also remains to be established in comparative studies that measure both durable control and operative morbidity.