The following is a summary of “Role of thymectomy in surgical treatment of renal hyperparathyroidism,” published in the July 2024 issue of Surgery by Guo et al.

The role of routine thymectomy in the surgical management of secondary or tertiary hyperparathyroidism (SHPT, THPT) remains controversial. This study aimed to assess the impact of thymectomy on recurrence rates and postoperative complications in patients undergoing subtotal parathyroidectomy for renal hyperparathyroidism. A retrospective review was conducted of patients treated at a tertiary endocrine surgery center from 2010 to 2022. Histopathological reports were examined to identify the presence of parathyroid tissue in resected specimens. Using multivariate logistic regression, the researchers compared baseline characteristics, recurrence rates, and complications between patients who underwent subtotal parathyroidectomy with and without concurrent thymectomy. Out of 107 patients who received subtotal parathyroidectomy, 29 (27.1%) also underwent thymectomy.

Recurrence of hyperparathyroidism was observed in 15 patients (14% of the cohort), but thymectomy did not significantly influence recurrence rates (odds ratio [OR] 0.33, 95% CI 0.06-1.28, p=0.14). However, thymectomy was associated with a higher risk of permanent hypoparathyroidism (OR 4.62, 95% CI 1.67-13.18, p=0.003). Furthermore, fewer parathyroid specimens were associated with a higher likelihood of undergoing thymectomy (p=0.04). Notably, parathyroid glands were identified in 6 of the thymectomy specimens (20.7%). In conclusion, while thymectomy during subtotal parathyroidectomy for renal hyperparathyroidism did not reduce recurrence rates, it was linked to an increased risk of permanent hypoparathyroidism. 

These findings suggest that routine thymectomy may not be warranted solely for recurrence prevention but may have implications for postoperative parathyroid function. Further investigation is needed to refine surgical strategies and improve patient outcomes.

Source: sciencedirect.com/science/article/abs/pii/S0002961024004161