Total parathyroidectomy and parathyroid autograft for renal osteodystrophy: Analysis of the cause of failure

Between September, 1979, and December 31, 1983, thirtyone patients with renal osteodystrophy and high serum immune parathyroid hormone (iPTH) levels underwent total parathyroidectomy with parathyroid autograft. Three failures (10%) were due to residual parathyroid tissue. In 2 of these patients, 4 and 6 glands respectively, had been removed. This indicates the need for thorough dissection of the neck even when 4 glands have been found. Painful symptoms and vitamin D3 intolerance persisted after surgery in 3 other patients (10%), although iPTH levels dropped significantly. Further work‐up disclosed aluminum intoxication.