Permanent postsurgical
hypoparathyroidism is defined as insufficient
parathyroid hormone (PTH) to maintain normocalcemia 6 months after surgery. It occurs mostly in reoperation for persistent or recurrent
hyperparathyroidism. The treatment of long-term
calcium and
vitamin D supplement is burdensome and may cause iatrogenic complications. PTH replacement is potential but still under trials. Only
replantation with cryopreserved parathyroid is an available treatment for patients to reduce or stop long-term
drug administration. However, this treatment is not applied widely in developing countries, due to lack of experiences and skills. Herein, we reported a 58-year-old male presented a continuous elevated
parathyroid hormone up to about 2342 ng/L and bone
pain during
hemodialysis for 6 years due to
chronic renal failure. He underwent the first operation total
parathyroidectomy and
autotransplantation. After this operation, he suffered from a persistent calcemia and permanent
hypoparathyroidism. After three times of
replantation with cryopreserved parathyroid and dialysis with a high
calcium dialysate, the low concentration of
calcium was elevated and symptoms of
hypocalcemia disappeared. However, PTH was not elevated significantly in the long term. It might be related to our nonstandard cryopreservation protocol and no microbiological and histological examinations before
replantation, compared with other successful reports. Therefore, we suggest a standard cryopreservation protocol should be followed by non-experienced institutions, especially in developing countries. Furthermore, a high
calcium dialysate is efficient to increase
calcium concentration and alleviate symptoms of
hypocalcemia. It may be an available treatment of persistent
hypocalcemia and permanent
hypoparathyroidism in dialysis patients.