Secondary Hyperparathyroidism in CKD: Comparative Case Series of Medical Management and Parathyroidectomy

In chronic kidney disease (CKD), disturbances in phosphate, calcium, and vitamin D balance often lead to secondary hyperparathyroidism (SHPT), which can progress to tertiary hyperparathyroidism if left untreated. We present three cases illustrating different management approaches: a 36-year-old male with refractory SHPT successfully treated with total parathyroidectomy, thymectomy, and forearm auto transplantation; a 63-year-old female on long-term dialysis who developed a spinal brown tumor from tertiary hyperparathyroidism, managed with parathyroidectomy and spinal decompression; and a 43-year-old male with stage V CKD whose SHPT was effectively controlled medically with Sevelamer, Alfacalcidol, and Cinacalcet. These cases emphasize that while medical therapy is effective in early, responsive SHPT, advanced or refractory disease often requires surgical intervention, highlighting the importance of timely diagnosis, individualized treatment, and multidisciplinary follow-up for optimal outcomes.