What is Tertiary Hyperparathyroidism?

Occasionally, if the causes of secondary hyperparathyroidism persist for some time, one parathyroid gland may become autonomous.The cells start producing excessive amounts of PTH even if the stimulus of low calcium is removed (e.g. after medical treatment).This is known as tertiary hyperparathyroidism.In these very rare circumstances parathyroid surgery is necessary to correct the autonomous parathyroid abnormality.

The exact type of operation performed depends on each individual situation. The two main operations performed in this case are:

• Subtotal parathyroidectomy - only some of the parathyroid tissue is removed leaving enough to render the patients' calcium levels within normal ranges.There is a recent vogue for subtotal parathyroidectomy-In previous years our endocrinolgists were keen for a small maybe around 80mgs of parathyroid tissue to be left in the neck.
• Total parathyroidectomy with auto-transplantation - this is where all the parathyroid tissue is removed. Some excised tissue is then dissected and a small amount reimplanted in the muscles of the neck or arm of the patient.This reimplanted tissue will take the place of a functioning gland.Mr Lynn has used this in the past but in recent years has given it up.

Which operation is performed depends on the exact state of the parathyroid glands as seen at operation, the expertise of the surgeon and the "protocol" agreed at the hospital.