Endocrine Presented at the Academic Surgical Congress 2016| Volume 161, ISSUE 4, P1139-1148, April 2017

Pattern of calcium and parathyroid hormone normalization at 12-months follow-up after parathyroid operation

Published:November 29, 2016DOI:


      At 12 months after a parathyroid operation, we expect cured patients to have biochemical profiles similar to those of healthy individuals. The aim of the current study was to compare the biochemical characteristics patients at 12 months after parathyroidectomy for primary sporadic hyperparathyroidism with those of healthy controls.


      A total of 547 patients who underwent parathyroid neck operation for primary sporadic hyperparathyroidism from 2000–2014 were analyzed. A control group consisted of 74 healthy subjects. Calcium and parathyroid hormone were collected perioperatively. Graphic plots of the relationship between calcium versus parathyroid hormone (95% confidence intervals) were used to compare the biochemical profiles of patients after parathyroid operation and controls.


      Preoperatively, patients with primary sporadic hyperparathyroidism had a calcium level of 10.9 ± 0.5 mg/dL and parathyroid hormone level of 124.4 ± 68.5 pg/dL vs controls' values of 9.2 ± 0.3 mg/dL and 34.4 ± 13.4 pg/dL, respectively. Before operation, all primary sporadic hyperparathyroidism patients had calcium versus parathyroid hormone values outside the normal zone. At 12 months after operation, 335 (69%) patients showed normalization of the chemical profile; 13 (2.7%) had absolute elevation of calcium and parathyroid hormone, reflecting persistent disease; 2 (0.4%) patients had hypoparathyroidism after subtotal parathyroidectomy; and 149 (31%) had calcium and parathyroid hormone values outside the normal zone, not fitting into the above categories. There were no marked differences between patients with simple adenoma those with multiple-gland disease.


      Longer follow-up might be needed for patients after parathyroid operation to confirm stabilization of biochemical profiles.
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        • Siperstein A.
        • Berber E.
        • Barbosa G.F.
        • Tsinberg M.
        • Greene A.B.
        • Mitchell J.
        • et al.
        Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intraoperative parathyroid hormone: analysis of 1,158 cases.
        Ann Surg. 2008; 248: 420-428
        • Press D.M.
        • Siperstein A.E.
        • Berber E.
        • Shin J.J.
        • Metzger R.
        • Monteiro R.
        • et al.
        The prevalence of undiagnosed and unrecognized primary hyperparathyroidism: a population-based analysis from the electronic medical record.
        Surgery. 2013; 154 (discussion 1237-8): 1232-1237
        • AACE/AAES Task Force on Primary Hyperparathyroidism
        The American Association of Clinical Endocrinologists and the American Association of Endocrine Surgeons position statement on the diagnosis and management of primary hyperparathyroidism.
        Endocr Pract. 2005; 11: 49-54
        • Lai V.
        • Yen T.W.
        • Doffek K.
        • Carr A.A.
        • Carroll T.B.
        • Fareau G.G.
        • et al.
        Delayed calcium normalization after presumed curative parathyroidectomy is not associated with the development of persistent or recurrent primary hyperparathyroidism.
        Ann Surg Oncol. 2016; 23: 2310-2314
        • Udelsman R.
        Approach to the patient with persistent or recurrent primary hyperparathyroidism.
        J Clin Endocrinol Metab. 2011; 96: 2950-2958
        • Stuart H.C.
        • Harvey A.
        • Pasieka J.L.
        Normocalcemic hyperparathyroidism: preoperatively a disease, postoperatively cured?.
        Am J Surg. 2014; 207 (discussion 680-1): 673-680
        • Westerdahl J.
        • Valdemarsson S.
        • Lindblom P.
        • Bergenfelz A.
        Postoperative elevated serum levels of intact parathyroid hormone after surgery for parathyroid adenoma: sign of bone remineralization and decreased calcium absorption.
        World J Surg. 2000; 24: 1323-1329
        • Yen T.W.
        • Wilson S.D.
        • Krzywda E.A.
        • Sugg S.L.
        The role of parathyroid hormone measurements after surgery for primary hyperparathyroidism.
        Surgery. 2006; 140 (discussion 672-4): 665-672
        • Carsello C.B.
        • Yen T.W.
        • Wang T.S.
        Persistent elevation in serum parathyroid hormone levels in normocalcemic patients after parathyroidectomy: does it matter?.
        Surgery. 2012; 152 (discussion 581-3): 575-581
        • Almquist M.
        • Bergenfelz A.
        • Martensson H.
        • Thier M.
        • Nordenstrom E.
        Changing biochemical presentation of primary hyperparathyroidism.
        Langenbecks Arch Surg. 2010; 395: 925-928
        • Mazeh H.
        • Chen H.
        • Leverson G.
        • Sippel R.S.
        Creation of a “wisconsin index” nomogram to predict the likelihood of additional hyperfunctioning parathyroid glands during parathyroidectomy.
        Ann Surg. 2013; 257: 138-141
        • Solorzano C.C.
        • Mendez W.
        • Lew J.I.
        • Rodgers S.E.
        • Montano R.
        • Carneiro-Pla D.M.
        • et al.
        Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism.
        Arch Surg. 2008; 143 (discussion 663): 659-663
        • Nordenstrom E.
        • Westerdahl J.
        • Bergenfelz A.
        Long-term follow-up of patients with elevated PTH levels following successful exploration for primary hyperparathyroidism.
        World J Surg. 2004; 28: 570-575
        • Oltmann S.C.
        • Maalouf N.M.
        • Holt S.
        Significance of elevated parathyroid hormone after parathyroidectomy for primary hyperparathyroidism.
        Endocr Pract. 2011; 17: 57-62
        • Nordenstrom E.
        • Westerdahl J.
        • Isaksson A.
        • Lindblom P.
        • Bergenfelz A.
        Patients with elevated serum parathyroid hormone levels after parathyroidectomy: showing signs of decreased peripheral parathyroid hormone sensitivity.
        World J Surg. 2003; 27: 212-215
        • Walker M.D.
        • Cong E.
        • Lee J.A.
        • Kepley A.
        • Zhang C.
        • McMahon D.J.
        • et al.
        Vitamin D in primary hyperparathyroidism: effects on clinical, biochemical, and densitometric presentation.
        J Clin Endocrinol Metab. 2015; 100: 3443-3451
        • Yamashita H.
        • Noguchi S.
        • Moriyama T.
        • Takamatsu U.
        • Sadanaga K.
        • Uchino S.
        • et al.
        Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism: importance of decreased renal parathyroid hormone sensitivity.
        Surgery. 2005; 137: 419-425
        • Untch B.R.
        • Barfield M.E.
        • Dar M.
        • Dixit D.
        • Leight Jr., G.S.
        • Olson Jr., J.A.
        Impact of 25-hydroxyvitamin D deficiency on perioperative parathyroid hormone kinetics and results in patients with primary hyperparathyroidism.
        Surgery. 2007; 142: 1022-1026
        • Goldfarb M.
        • Gondek S.
        • Irvin 3rd, G.L.
        • Lew J.I.
        Normocalcemic parathormone elevation after successful parathyroidectomy: long-term analysis of parathormone variations over 10 years.
        Surgery. 2011; 150: 1076-1084
        • Jin J.
        • Mitchell J.
        • Shin J.
        • Berber E.
        • Siperstein A.E.
        • Milas M.
        Calculating an individual maxPTH to aid diagnosis of normocalemic primary hyperparathyroidism.
        Surgery. 2012; 152: 1184-1192