Abstract
Background. Intraoperative intact parathyroid hormone (iPTH) is being used to confirm complete
excision of hyperfunctioning parathyroid tissue. It is uncertain whether normalization
of intraoperative iPTH levels accurately predicts long-term postoperative iPTH values.
Methods. Fifty-two consecutive patients with primary or secondary hyperparathyroidism underwent
parathyroidectomy with measurement of intraoperative iPTH. Ten patients were excluded
due to incomplete laboratory follow-up. Follow-up serum calcium and iPTH levels were
measured at 1- and 3-month intervals. Results. Before operation, the mean serum iPTH level was 249 pg/mL (SD=208) and mean serum
calcium level was 11.4 ± 0.9 mg/dL (± SD). In all but 4 patients, final intraoperative
iPTH levels normalized to less than 67 ± 41 pg/mL (mean, 35 pg/mL). One week after
operation, serum calcium levels had returned to normal (mean, 9.4 ± 1.1 pg/mL), which
directly correlated with the final intraoperative serum iPTH values (Pearson correlation,
r = −.434; P <.01). By 1 month, all but 2 patients were normocalcemic (mean, 9.4 ± 0.9 pg/mL)
with a mean iPTH level of 74.8 ± 82 pg/mL. There was no correlation between final
intraoperative and postoperative serum iPTH values (r =.099; P <.533). Both patients with persistent hypercalcemia at 1 month had appropriate intraoperative
decreases in iPTH values. Conclusions. Intraoperative serum iPTH levels significantly correlate with postoperative serum
calcium levels but not with postoperative serum iPTH levels. There was a 4.8% failure
rate in the correction of postoperative serum calcium levels and a 29% failure rate
in the normalization of postoperative serum iPTH levels. (Surgery 2000;128:930-6.)
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy.Surgery. 1996; 120: 954-958
- Improved success rate in reoperative parathyroidectomy with intraoperative PTH assay.Ann Surg. 1998; 229: 874-879
- Intraoperative parathyroid hormone monitoring during parathyroidectomy for secondary hyperparathyroidism.Surgery. 1997; 122: 1034-1039
- Side localization of parathyroid adenomas by simplified intraoperative venous sampling for parathyroid hormone.World J Surg. 1996; 20: 358-360
- A new, practical intraoperative parathyroid hormone assay.Am J Surg. 1994; 168: 466-468
- Initial experience with intraoperative PTH determinations in the surgical management of 130 consecutive cases of primary hyperparathyroidism.Surgery. 1999; 126: 1132-1138
- Persistent elevated serum levels of intact parathyroid hormone after operation for sporadic parathyroid adenoma: evidence of detrimental effects of sever parathyroid disease.Surgery. 1996; 119: 624-633
- The validity of quick intraoperative parathyroid hormone assay: an evaluation in seventy-two patients based on gross morphologic criteria.Surgery. 1999; 126: 1030-1035
- Intraoperative elevation of intact PRT in the presence of normocalcemia after successful surgery for primary hyperparathyroidism.Endocr J. 1998; 45: 609-616
- Transient rise in intact parathyroid hormone concentration after surgery for primary hyperparathyroidism.Br J Surg. 1996; 83: 665-669
- Parathyroid metabolism after operative treatment of hypercalcemic hyperparathyroidism.Surgery. 1987; 102: 898-902
- Parathyroid hormone: before and after parathyroidectomy.Surgery. 1986; 100: 1021-1031
Article info
Footnotes
*Reprint requests: Richard A. Prinz, MD, Department of General Surgery, Rush-Presbyterian-St. Luke's Medical Center, 1653 W Congress Parkway, Chicago, IL 60612.
**Surgery 2000;128:930-6.
Identification
Copyright
© 2000 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Late parathyroid function after successful parathyroidectomy guided by intraoperative hormone assay (QPTH) compared with the standard bilateral neck explorationSurgeryVol. 128Issue 6
- PreviewBackground. Controversy continues between bilateral neck exploration and limited parathyroidectomy. One approach depends on gland size and histopathologic factors; the other approach limits excision to only hypersecreting glands. Both have excellent early operative success, but late recurrence rates with limited exploration are unknown. Methods. Three hundred twenty consecutive patients with primary hyperparathyroidism were followed 6 to 313 months after successful parathyroidectomy. One hundred seventy-six patients had bilateral neck exploration with excision of enlarged glands (group I); 144 patients had glands excised based on hyper-secretion (group II).
- Full-Text
- Preview
