Role of thymectomy in surgical treatment of renal hyperparathyroidism

• Published in: The American journal of surgery Vol. 237; p. 115864
• Main Authors: Guo, Michael Y., Pillar, Michal, Manhas, Neraj, Melck, Adrienne
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2024; Elsevier Limited
• Subjects: Hemodialysis; Hypercalcemia; Hyperparathyroidism; Hypoparathyroidism; Information systems; Kidney diseases; Parathyroid; Parathyroidectomy; Pathology; Patients; Persistent hyperparathyroidism; Recurrent hyperparathyroidism; Secondary hyperparathyroidism; Surgeons; Surgery; Tertiary hyperparathyroidism; Thymectomy; Thymus gland; Recurrent hyperparathyroidism; Tertiary hyperparathyroidism; Thymectomy; Persistent hyperparathyroidism; Secondary hyperparathyroidism
• ISSN: 0002-9610; 1879-1883; 1879-1883
• DOI: 10.1016/j.amjsurg.2024.115864

The role for routine thymectomy in patients with secondary or tertiary hyperparathyroidism (SHPT, THPT) is unclear. We aim to compare rates of recurrence and complications in patients who underwent subtotal parathyroidectomy with and without thymectomy. Patients who underwent surgery for renal HPT at a tertiary endocrine surgery center between 2010 and 2022 were reviewed. Presence of parathyroid tissue in resected tissue was identified through pathology reports. A multivariate logistic regression was used to compare baseline characteristics, recurrence rates and complications between those who did and did not undergo thymectomy. Of 107 patients who underwent subtotal parathyroidectomy, 29 (27.1 ​%) underwent concomitant thymectomy. Recurrence occurred in 15 patients (14 ​%). Thymectomy did not affect recurrence (OR: 0.33, 95%CI: 0.06–1.28, p ​= ​0.14), but was associated with permanent hypoparathyroidism (OR: 4.62, 95%CI: 1.67–13.18, p ​= ​0.003). Fewer parathyroid specimens increased the odds of thymectomy (p ​= ​0.04). Parathyroid glands were found in 6 thymectomy samples (20.7 ​%). Thymectomy at the time of subtotal parathyroidectomy for renal HPT was not associated with disease recurrence, but increased likelihood of permanent hypoparathyroidism. [Display omitted] •Omitting a cervical thymectomy is not associated with lower cure rates.•Cervical thymectomy is associated with higher risk of permanent hypocalcemia (at 6 months).•Thymus glands may harbour less parathyroid tissue than previously believed.•Large variations in recurrence rates likely result from inconsistent definitions of disease cure.