Persistently elevated parathyroid hormone after successful parathyroid surgery

Area of Science:

• Endocrinology
• Nephrology
• Surgical Oncology

Background:

• Primary hyperparathyroidism (PHPT) is a common endocrine disorder.
• Parathyroidectomy is the definitive treatment for PHPT.
• Persistent elevated parathyroid hormone (PTH) after successful parathyroidectomy can occur, necessitating further investigation.

Purpose of the Study:

• To explore potential causes of persistently elevated PTH levels after curative parathyroidectomy in patients with PHPT due to single-gland disease.
• To identify factors associated with elevated postoperative PTH in eucalcemic patients.

Main Methods:

• A case series analysis of 119 patients with single-gland PHPT who underwent parathyroidectomy.
• Preoperative and postoperative PTH, calcium, ionized calcium, 25-OH-vitamin D, creatinine, and glomerular filtration rate (GFR) were analyzed.
• Patients were categorized into elevated PTH and normal PTH groups post-surgery.

Main Results:

• Twenty-five percent (25.2%) of patients had elevated postoperative PTH despite normocalcemia.
• This group exhibited significantly higher preoperative PTH and creatinine levels, and lower GFR.
• Impaired renal function (abnormal GFR) was strongly associated with elevated postoperative PTH (OR: 12.8).

Conclusions:

• Elevated PTH post-parathyroidectomy in eucalcemic patients is associated with higher preoperative PTH and impaired renal function.
• Low 25-OH-vitamin D levels were not significantly linked to persistent elevated PTH.
• Understanding these factors is crucial for managing PHPT outcomes.