Day zero parathyroid hormone levels predict cure after parathyroidectomy

Area of Science:

• Endocrinology
• Surgical Oncology
• Diagnostic Accuracy Studies

Background:

• Primary hyperparathyroidism (pHPT) is a common endocrine disorder often treated with parathyroidectomy.
• Accurate assessment of surgical success is crucial for patient management and minimizing recurrence.
• Early post-operative biochemical markers can aid in determining surgical outcomes.

Purpose of the Study:

• To assess the predictive value of day zero post-operative parathyroid hormone (PTH) levels for cure in patients with pHPT.
• To establish an optimal PTH cut-off value for predicting successful parathyroidectomy.
• To evaluate the diagnostic accuracy of early post-operative PTH levels in confirming cure.

Main Methods:

• A multicentre, retrospective diagnostic accuracy study involving patients who underwent parathyroidectomy for pHPT.
• Day zero post-operative PTH levels were analyzed as the predictor variable.
• Cure at 6 months (normocalcaemia) was the outcome measure; diagnostic parameters were calculated using ROC curve analysis and Youden's index.

Main Results:

• Of 291 patients, 95.5% achieved cure at 6 months.
• An optimal PTH cut-off of <3 pmol/L was identified.
• Patients with day zero PTH <3 pmol/L (77.7% of cohort) showed 100% cure rate, with 81.3% sensitivity and 100% specificity.

Conclusions:

• Day zero post-operative PTH level <3 pmol/L is a reliable indicator of cure for pHPT following parathyroidectomy.
• This PTH cut-off effectively identifies cured patients, potentially reducing the need for prolonged biochemical monitoring.
• Early post-operative PTH measurement offers a valuable tool for assessing parathyroidectomy success.