Surgical treatment of secondary hyperparathyroidism               DAI Wen-jie, XU De-quan. Department of Thyroid-breast-cell-transplantation Surgery, the First  Affiliated Hospital of Harbin Medical University, Harbin 150001, China
Corresponding author: DAI Wen-jie, E-mail: davidhmu@163.com
Abstract    Secondary hyperparathyroidism (SHPT) refers to a derangement in calcium homeostasis leading to a compensatory increase in parathyroid hormone (PTH) secretion. Most SHPT patients depend on medication. SHPT requiring parathyroidectomy (PTx) occurs more commonly in progressive chronic kidney disease (CKD) and in long-term lithium therapy. At present, after thoughtful review which procedure is the most suitable operative procedure for patients with advanced SHPT still can’t be determined. The decision may depend on the surgeon's preference and the clinical status of the patients. Important patient issues in choosing a specific procedure is whether the patient is a candidate for kidney transplantation, patient age, expected survival after PTx, and the patient's ability to obtain and comply with medication. For patients who require long-term hemodialysis after PTx, the risk for recurrence is not negligible, as it is easier and safer to remove residual parathyroid tissue from the forearm at recurrence as compared with a neck reexploration. Thus, total PTx with forearm autograft is the preferred option in a patient who has to continue hemodialysis for long periods after PTx.