Advanced secondary (renal) hyperparathyroidism (HPT) induced by long-standing chronic renal insufficiency can be a serious complication for patients receiving long-term hemodialysis. As Zaraca and colleagues have pointed out, parathyroidectomy is indicated for patients with advanced secondary HPT that is refractory to medical management; many patients feel dramatically better within days of the operation. The questions that remain, therefore, are when to operate and which operation to perform. Zaraca et al address the second question.
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