Subtotal parathyroidectomy for tertiary hyperparathyroidism thirty-two months after renal transplantation

A patient is reported who had persistent hypercalcemia for thirty-two months after renal transplantation. The incidence of tertiary hyperparathyroidism after transplantation for chronic renal disease appears to be between 1 and 7 per cent. The etiology, management, and complications of parathyroid hyperplasia are reviewed. It is suggested that this complication is not reversible in some instances and that an arbitrary period of nine months to one year of medical management be allowed prior to surgical intervention by subtotal parathyroidectomy.