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Normalization of intraoperative parathyroid hormone does not predict normal postoperative parathyroid hormone levels
F L Starr1, R DeCresce, R A Prinz
1Department of General Surgery, Rush-Presbyterian-St Luke's Medical Center, Chicago, IL 60612, USA.
Surgery
|December 15, 2000
Summary
Intraoperative intact parathyroid hormone (iPTH) monitoring during parathyroidectomy correlates with postoperative calcium levels, but not with long-term iPTH values. This suggests iPTH may not reliably predict normalization of parathyroid hormone after surgery.
Area of Science:
- Endocrinology
- Surgical Oncology
- Biochemistry
Background:
- Intraoperative intact parathyroid hormone (iPTH) is utilized to confirm complete excision of hyperfunctioning parathyroid tissue during parathyroidectomy.
- The predictive accuracy of intraoperative iPTH normalization for long-term postoperative iPTH levels remains uncertain.
Purpose of the Study:
- To evaluate the correlation between intraoperative intact parathyroid hormone (iPTH) levels and long-term postoperative iPTH and serum calcium levels following parathyroidectomy.
Main Methods:
- Fifty-two patients with primary or secondary hyperparathyroidism underwent parathyroidectomy with intraoperative iPTH measurements.
- Follow-up serum calcium and iPTH levels were assessed at 1- and 3-month intervals post-surgery.
Main Results:
- Intraoperative iPTH levels normalized in most patients (mean 35 pg/mL).
- Postoperative serum calcium levels normalized by 1 week and correlated with intraoperative iPTH (r = -.434; P <.01).
- No correlation was found between final intraoperative and postoperative iPTH values (r =.099; P <.533).
Conclusions:
- Intraoperative iPTH levels correlate with postoperative serum calcium but not with postoperative serum iPTH levels.
- A 4.8% failure rate was observed in correcting postoperative serum calcium levels.
- A significant 29% failure rate occurred in normalizing postoperative serum iPTH levels.