Background
Patients with primary hyperparathyroidism who undergo minimally invasive parathyroidectomy
(MIP) may have postoperative symptoms of hypocalcemia or secondary hyperparathyroidism.
This study sought to identify factors predictive of these events.
Methods
Between 1998 and 2004, 190 patients with primary hyperparathyroidism underwent MIP
with excision of a single adenoma. Age, gender, race, prior head and neck surgery,
use of preoperative thyroid hormone or calcium-channel blockers, preoperative levels
of calcium, 25-hydroxyvitamin D (25[OH]D) and intact parathyroid hormone (iPTH), the
presence of osteopenia or osteoporosis, intraoperative iPTH levels, and adenoma weight
were evaluated by univariate analysis as predictors of postoperative symptoms of hypocalcemia
and secondary hyperparathyroidism.
Results
None of the following were predictors of postoperative symptoms of hypocalcemia: age,
gender, race, prior head and neck surgery, preoperative medications, preoperative
calcium and iPTH levels, osteopenia or osteoporosis, intraoperative iPTH levels, or
adenoma weight. However, patients with postoperative symptoms of hypocalcemia had
significantly lower preoperative 25[OH]D levels (P = .01). Further, higher preoperative
iPTH levels (P < .01) and lower preoperative 25[OH]D levels (P = .05) were associated
with secondary hyperparathyroidism postoperatively.
Conclusions
A low preoperative 25[OH]D level is associated with postoperative symptoms of hypocalcemia
and secondary hyperparathyroidism in patients undergoing MIP. One might consider instituting
empiric calcium supplementation postoperatively in patients with low 25[OH]D levels.
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Article info
Publication history
Accepted:
September 22,
2005
Baltimore, MdIdentification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
