Intraoperative parathyroid hormone levels dynamics of cured patients with impaired renal function following parathyroidectomy for primary hyperparathyroidism

Published:October 11, 2022DOI:



      Intraoperative parathyroid hormones have been used to establish operative success in patients with primary hyperparathyroidism. This study’s aim was to assess the impact of estimated glomerular filtration rate and serum creatinine levels on the fulfillment of >50% drop and normalization of intraoperative parathyroid hormone levels.


      Patients successfully treated for primary hyperparathyroidism were analyzed. The samples for parathyroid hormone were collected at baseline, 5-, 10-, and 30-minutes postexcision. The patients were classified as follows: (1) estimated glomerular filtration rate >60 mL/min, (2) estimated glomerular filtration rate <60 mL/min and serum creatinine levels <1.2 mg/dL, and (3) estimated glomerular filtration rate <60 mL/min and serum creatinine levels >1.2 mg/dL. Comparative analysis of patients achieving the >50% parathyroid hormone drop criterion and normalization of intraoperative parathyroid hormone was performed.


      One hundred-fourteen patients were distributed as follows: 88 patients (77.2%), 14 (12.3%), and 12 (10.5%) for groups 1, 2 and 3, respectively. No difference between groups in the proportion of patients fulfilling the >50% parathyroid hormone drop criterion was found. An abnormally elevated intraoperative parathyroid hormone level at 30-minute postexcision was observed in 0, 14.3, and 16.6% in groups 1, 2, and 3, respectively (P ≤ .0001).


      In the study, >50% parathyroid hormone drop criterion was equally achieved despite normal or reduced estimated glomerular filtration rate. When serum creatinine levels increased >1.2 mg/dL and estimated glomerular filtration rate declined <60 mL/min, the likelihood of reaching normal intraoperative parathyroid hormone levels postexcision was significantly lower.
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        • Walker M.D.
        • Silverberg S.J.
        Primary hyperparathyroidism.
        Nat Rev Endocrinol. 2018; 14: 115-125
        • Silverberg S.J.
        • Clarke B.L.
        • Peacock M.
        • et al.
        Current issues in the presentation of asymptomatic primary hyperparathyroidism: proceedings of the Fourth International Workshop.
        J Clin Endocrinol Metab. 2014; 99: 3580-3594
        • Calò P.G.
        • Pisano G.
        • Loi G.
        • et al.
        Intraoperative parathyroid hormone assay during focused parathyroidectomy: the importance of 20 minutes measurement.
        BMC Surg. 2013; 13: 36
        • Barczynski M.
        • Konturek A.
        • Hubalewska-Dydejczyk A.
        • Cichon S.
        • Nowak W.
        Evaluation of Halle, Miami, Rome, and Vienna intraoperative iPTH assay criteria in guiding minimally invasive parathyroidectomy.
        Langenbecks Arch Surg. 2009; 394: 843-849
        • Irvin G.L.
        • Dembrow V.D.
        • Prudhomme D.L.
        Operative monitoring of parathyroid gland hyperfunction.
        Am J Surg. 1991; 162: 299-302
        • Gauger P.G.
        • Agarwal G.
        • England B.G.
        • et al.
        Intraoperative parathyroid hormone monitoring fails to detect double parathyroid adenomas: a 2-institution experience.
        Surgery. 2001; 130: 1005-1010
        • Libutti S.K.
        • Alexander H.R.
        • Bartlett D.L.
        • et al.
        Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism.
        Surgery. 1999; 126: 1145-1151
        • Richards M.L.
        An optimal algorithm for intraoperative parathyroid hormone monitoring.
        Arch Surg. 2011; 146: 280
        • Rudin A.V.
        • McKenzie T.J.
        • Wermer R.A.
        • Thompson G.B.
        • Lyden M.L.
        Primary hyperparathyroidism: redefining cure.
        Am Surg. 2019; 85: 214-218
        • Armitage E.K.
        Parathyrin (parathyroid hormone): metabolism and methods for assay.
        Clin Chem. 1986; 32: 418-424
        • Egan R.J.
        • Iliff H.
        • Stechman M.J.
        • Scott-Coombes D.M.
        Intraoperative parathyroid hormone assay remains predictive of cure in renal impairment in patients with single parathyroid adenomas.
        World J Surg. 2018; 42: 2835-2839
        • Vulpio C.
        • Bossola M.
        • Di Stasio E.
        • et al.
        Intra-operative parathyroid hormone monitoring through central laboratory is accurate in renal secondary hyperparathyroidism.
        Clin Biochem. 2016; 49: 538-543
        • Sohn J.A.
        • Oltmann S.C.
        • Schneider D.F.
        • Sippel R.S.
        • Chen H.
        • Elfenbein D.M.
        Is intraoperative parathyroid hormone testing in patients with renal insufficiency undergoing parathyroidectomy for primary hyperparathyroidism accurate?.
        Am J Surg. 2015; 209: 483-487
        • Cockcroft D.W.
        • Gault M.H.
        Prediction of creatinine clearance from serum creatinine.
        Nephron. 1976; 16: 31-41
        • Graves C.E.
        • Hwang R.
        • McManus C.M.
        • Lee J.A.
        • Kuo J.H.
        The effect of chronic kidney disease on intraoperative parathyroid hormone: a linear mixed model analysis.
        Surgery. 2021; 169: 1152-1157
        • Sunkara B.
        • Cohen M.S.
        • Miller B.S.
        • Gauger P.G.
        • Hughes D.T.
        Influence of concurrent chronic kidney disease on intraoperative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism.
        Surgery. 2018; 163: 42-47
        • Marcadis A.R.
        • Teo R.
        • Ouyang W.
        • Farrá J.C.
        • Lew J.I.
        Successful parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism is preserved in mild and moderate renal insufficiency.
        Surgery. 2018; 163: 633-637
        • Gannagé-Yared M.H.
        • Abboud B.
        • Amm-Azar M.
        • et al.
        Predictors of intra-operative parathyroid hormone decline in subjects operated for primary hyperparathyroidism by minimally invasive parathyroidectomy.
        J Endocrinol Invest. 2009; 32: 160-164
        • Leiker A.J.
        • Yen T.W.F.
        • Eastwood D.C.
        • et al.
        Factors that influence parathyroid hormone half-life: determining if new intraoperative criteria are needed.
        JAMA Surg. 2013; 148: 602