What are the conditions to choose total parathyroidectomy vs subtotal parathyroidectomy?

The choice between total parathyroidectomy and subtotal (or partial) parathyroidectomy depends on the underlying medical condition and the specific goals of the surgery. Both procedures are surgical interventions used to treat hyperparathyroidism, a condition characterized by excessive production of parathyroid hormone (PTH) by the parathyroid glands. Hyperparathyroidism can be caused by different factors, and the surgical approach is tailored to address the specific cause and severity of the condition.

Total Parathyroidectomy: In total parathyroidectomy, all four parathyroid glands are removed. This procedure is typically considered in the following situations:

  1. Hyperplasia: If all four parathyroid glands are enlarged or hyperactive (parathyroid hyperplasia), total parathyroidectomy may be necessary to remove all the abnormal glands.
  2. Recurrent Hyperparathyroidism: If a patient has had previous parathyroid surgery (subtotal parathyroidectomy) and the hyperparathyroidism has returned, total parathyroidectomy may be considered to ensure complete removal of any remaining hyperactive glands.
  3. Parathyroid Cancer: In cases of parathyroid cancer, total parathyroidectomy is often performed to remove the entire parathyroid tissue and reduce the risk of recurrence.
  4. Chronic Kidney Disease: In patients with severe chronic kidney disease and secondary hyperparathyroidism, total parathyroidectomy may be necessary to control elevated PTH levels and calcium levels.

Subtotal (Partial) Parathyroidectomy: In subtotal parathyroidectomy, only a portion of the parathyroid tissue is removed, leaving a small remnant of one or more glands. This procedure is typically considered in the following situations:

  1. Primary Hyperparathyroidism: In cases of primary hyperparathyroidism with a single adenoma (most common cause), removing the adenoma and leaving a portion of one or more normal parathyroid glands can help maintain adequate parathyroid function while treating the underlying problem.
  2. Renal Hyperparathyroidism: In patients with secondary hyperparathyroidism due to chronic kidney disease, a subtotal parathyroidectomy may be performed to reduce PTH levels while preserving some parathyroid function.
  3. Familial Hyperparathyroidism: In certain inherited forms of hyperparathyroidism, such as multiple endocrine neoplasia type 1 (MEN1), subtotal parathyroidectomy may be performed to address the condition while avoiding the risks of total parathyroidectomy.

The decision to choose total parathyroidectomy or subtotal parathyroidectomy is made based on factors such as the underlying cause of hyperparathyroidism, the extent of parathyroid involvement, the patient’s overall health, and the surgeon’s experience and judgment.

It’s important for patients to have a thorough discussion with their endocrinologist and surgeon to understand the specific indications and risks associated with each surgical approach and make an informed decision tailored to their individual needs and medical condition.