Hyperparathyroidism, Secondary, Chronic Renal Disease

44 years old / female with chronic renal disease, on dialysis, with persistently high parathyroid hormone levels and low calcium, with calcium deposits on right shoulder labeled as myositis ossificans on x-ray, negative sestamibi scan.

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With right shoulder deformity – due to calcium deposition on the soft tissue particularly on the muscles.

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Calcifications on the soft tissue of right shoulder

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Left parathyroids – hyperplastic (enlarged)

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Right parathyroids – hyperplastic (enlarged)

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The 4 hyperplastic parathyroids – largest at right upper – about 2 cm.

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Neck incision for the parathyroidectomy

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One parathyroid at the left lower chosen to be minced and transplanted – one half of the whole – about 3 mm.

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Minced parathyroid

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Minced parathyroid placed in a pocket in the left sternocleidomastoid muscle (arms full of scars and with arteriovenous fistula)

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Closure of pocket with silk suture to facilitate identification if there is a need to do a reduction of the parathyroid in the future

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Resultant neck incisions – parathyroidectomy and parathyroid transplantation

ROJ@16jun6

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