The correction of secondary hyperthyroidism by local vitamin D injection in parathyroid glands
Abstract
Aim: The study was performed to show the efficiency of local vitamin D3 injection in parathyroid glands in management of secondary hyperparathyroidism and to reveal optimal conditions for this treatment. Results: Forty-six series of local injection of paricalcitol in the parathyroid gland under ultrasound guidance where performed in 37 patients with CKD 5D, receiving renal replacement therapy (16 - HD, 21 - CAPD) with manifestations of secondary hyperparathyroidism resistant to conservative therapy. As a result of the interventions a statistically significant reduction in PTH levels by 22.7% (190 pg/ml, 95% CI - 87 ÷ 293, p=0.001) was achieved. A significant difference in the trends of PTH before and after the intervention during 6 and 12 months was observed. A significant reduction of the maximal linear dimension (in average by 17.1%) and a downward trend in the estimated volume (in average by 12.5%) were revealed in 6 months after the injections. Regression analysis showed a statistically significant dependence of the gland volume changes upon the calculated gland volume before the intervention in the quadratic regression model. The most significant decrease in the volume was noted at the baseline calculated gland volume from 0.2 to 0.5 cm3. No gland volume reduction was found if the calculated volume was less than 0.1 cm3. The magnitude of the PTH level changes did not depend on the baseline calculated parathyroid gland volume. Conclusion: Repeated vitamin D injections in parathyroid glands under ultrasound control can be efficient treatment additional to medicamentous therapy when the glands size is in range 0.2-0.5 sm3 and the PTH level is lower 1000 pg/ml.
About the Authors
R. P. Gerasimchuk
City Mariinsky hospital - City nephrology center; I.I. Mechnikov North-West State medical university
Russian Federation
Russian Federation
S. B. Kondakov
City Mariinsky hospital - City nephrology center
Russian Federation
Russian Federation
A. Yu. Zemchenkov
City Mariinsky hospital - City nephrology center; I.I. Mechnikov North-West State medical university; I.P. Pavlov First St.-Petersburg State medical university
Russian Federation
Russian Federation
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Review
For citations:
Gerasimchuk R.P., Kondakov S.B., Zemchenkov A.Yu. The correction of secondary hyperthyroidism by local vitamin D injection in parathyroid glands. Nephrology and Dialysis. 2015;17(1):58-66. (In Russ.)
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