原发性甲状旁腺功能亢进症的定位诊断与手术治疗

目的探讨原发性甲状旁腺功能亢进症的定位诊断与治疗方法。方法回顾性分析近15年来手术治疗的52例原发性甲状旁腺功能亢进症患者的临床资料。结果所有病例均在术前行B超和X线检查,99mmTc-MIBI核素扫描36例,所有病例均术中静脉快速滴注亚甲蓝。行甲状旁腺腺瘤切除术45例(小切口腺瘤切除18例),甲状旁腺增生切除术4例,根治性甲状旁腺癌切除术3例。病理性骨折18例,骨、关节痛22例,泌尿系结石病变6例,无症状者6例。X线检查全组患者均表现为骨质疏松。全组血钙升高在2.7-4.3mmol/L之间,平均(3.0±0.5)mmol/L。38例患者术前测定甲状旁腺激素升高在305-1813pg/mL之间,平均(628.3±87.6)pg/mL。B超术前定位诊断率82.6%,99mmTc-MIBI核素扫描的定位诊断率88.9%,术中静滴亚甲蓝染色定位诊断率96.2%。术后36例患者出现短期低血钙,24例出现面部、手足麻木,12例出现手足抽搐,经钙剂治疗血钙恢复正常。患者术后甲状旁腺激素均恢复正常,3例甲状旁腺癌患者术后升高,经再次手术恢复正常。45例获随访,随访时间3个月至15年,临床症状缓解,骨质疏松改善,骨折愈合。结论小创伤甲状旁腺切除是治疗原发性甲状旁腺功能亢进症的有效方法。术中亚甲蓝染色结合术前B超、核素扫描定位诊断原发性甲状旁腺功能亢进症,使甲状旁腺肿瘤切除术准确和微创。     

原发性甲状旁腺功能亢进症临床分析（附138例报告）

目的 总结原发性甲状旁腺功能亢进症的诊治体会。方法 回顾性分析本院普通外科2015年1月至2017年11月经手术治疗的138例原发性甲状旁腺功能亢进症病人的临床资料。结果 138例病人,男30例,女108例,均行手术治疗,其中甲状旁腺危象5例,1例行急诊手术治疗。切除病变甲状旁腺150枚。术后病理检查显示：123枚（82.0%）为甲状旁腺腺瘤,9枚（6.0%）为甲状旁腺增生,4枚（2.7%）为甲状旁腺癌,10枚（6.6%）为甲状旁腺囊肿,4枚（2.7%）为甲状旁腺非典型腺瘤。术后第1天甲状旁腺素（parathyroid hormone, PTH）均降至正常,血钙下降。其中48例术后出现低血钙症状,经补充活性维生素D和葡萄糖酸钙,恢复正常。无喉返神经损伤等并发症发生。结论 血钙和PTH可作为原发性甲状旁腺功能亢进的初步诊断方法。甲状旁腺切除术是有效治疗手段。术前准确定位有助于缩小探查范围。对于甲状旁腺危象,给予水化利尿及双膦酸盐降钙治疗、及时早期行甲状旁腺切除术,可取得良好治疗效果。     

原发性甲状旁腺功能亢进症的外科治疗

目的:总结原发性甲状旁腺功能亢进症的外科治疗经验。方法:分析3年间收治的9例原发性甲状旁腺功能亢进症患者的临床资料。9例中术前有骨关节疼痛4例, 骨折1例, 泌尿系结石症状3例，有肾病表现1例。所有患者术前血钙均升高，平均3 145 mmol/L，术前PTH平均186 ng/L， 全组病例经术前影像学定位后均行手术治疗。 结果:术后血钙明显下降, 平均血钙为1 775 mmol/L。术中切除甲状旁腺肿物15 min后测血PTH分别下降66％。9例术中均暴露喉返神经，术后无1例出现声嘶。术后8例均随访1个月至3年, 术后临床表现缓解, 骨质疏松改善。结论:甲状旁腺切除术是治疗原发性甲状旁腺功能亢进症的有效方法，经术前影像学定位后，术中PTH检测，行小范围、小创伤的甲状旁腺切除术是可行的。暴露喉返神经行甲状旁腺切除术更安全。     

原发性甲状旁腺功能亢进症66例分析

目的：探讨原发性甲状旁腺功能亢进症及合并高钙危象的诊断与治疗。方法：66例原发性甲状旁腺功能亢进症患者均经手术治疗,59例甲状旁腺腺瘤、4例甲状旁腺增生仅行肿物切除,3例甲状旁腺癌同时切除同侧甲状腺、峡部及周围软组织。结果：66例患者均治愈,术后无甲状旁腺功能减低或喉返神经损伤等并发症。合并高钙危象患者经快速大量补液、利尿、降钙并结合手术治疗,术后血钙下降至正常水平。结论：血钙和甲状旁腺素可作为初步诊断方法,B超及99mTc-MIBI可做出定位诊断,甲状旁腺肿物切除术是有效治疗手段。     

原发性甲状旁腺功能亢进60例外科治疗体会

目的 总结原发性甲状旁腺功能亢进的诊断、手术治疗经验。方法 对1992年1月至2012年12月哈尔滨医科大学附属第一医院甲状腺乳腺外科收治的60例原发性甲状旁腺功能亢进病人的资料进行回顾性分析。结果 60例均行手术治疗,男性14例,女性46例。切除病变甲状旁腺74枚。术后病理证实：61枚（82.4%）为甲状旁腺腺瘤,13枚（17.6%）为甲状旁腺增生 ,无甲状旁腺癌结果回报。60例行病变甲状旁腺切除术后甲状旁腺激素（PTH）均降至正常,血钙下降。其中11例术后出现低血钙症状,经补充维生素D和葡萄糖酸钙,血钙恢复正常。无其他并发症。结论 完善的术前评估、围手术期正确的处理、术中精细操作、个体化治疗,能降低手术并发症的发生率,提高病人的生活质量。     

原发性甲状旁腺功能亢进症73例诊治分析

目的 探讨原发性甲状旁腺功能亢进症(PHPT)的诊断及治疗方法.方法 回顾分析我院2000年至2009年间收治的73例PHPT 患者的临床资料.结果 全组血钙均升高,均值(3.05±0.49)mmol/L,最高血钙值均值(3.28±0.62)mmol/L.69例测定甲状旁腺激素(PTH),全部增高(119.46～5000.00pg/ml).联合B超、99mTc-MIBI、CT、MIR定位准确率达91.78%.73例均行手术治疗,病理证实甲状旁腺腺瘤72例,甲状旁腺增生1例,部分患者合并甲状腺疾病.术后患者症状改善,血清钙、PTH恢复正常或明显下降.结论 应提高对PHPT的认识,确诊者应尽早手术.     

原发性甲状旁腺功能亢进症的围手术期处理

目的 :探讨围手术期处理对原发性甲状旁腺功能亢进症 (PHPT)治疗效果的影响。方法 :对近 10年治疗 2 6例PHPT的围手术期处理进行回顾性分析总结。结果 :病人术前血清钙 3.31mmol/L ,5例出现高血钙危象 (血清钙 :3.7～ 4 .5mmol/L)。术后第 4天血清钙降低至最低点 (1.74mmol/L)。血清甲状旁腺激素由术前 10 5 0 .7pg/ml恢复至正常的 17.12 pg/ml。 2例由于未能及时治疗而死亡 ,分别为心搏骤停和左心功能不全 ,全组累积死亡率为 11.5 % (3/ 2 6 )。结论 :重视围手术期的处理是PHPT治疗的重要环节 ;对高血钙危象的有效治疗必须尽早开始 ,以挽救病人生命     

无症状原发性甲状旁腺功能亢进症的治疗

目的 探讨无症状原发性甲状旁腺功能亢进症(PHPT)的诊断和治疗方法 .方法 回顾性分析1990年1月至2006年12月间收治的46例PHPT患者的临床资料,其中5例为无症状PHPT,均为女性,年龄54～71岁.5例患者中3例为体检发现,1例因疲乏无力就诊而发现,1例误诊为甲状腺肿物,后经手术及病理学检查证实为甲状旁腺病变.4例血钙及血甲状旁腺素(PTH)高于正常范围,1例血钙及血PTH正常.5例患者均接受手术治疗,均为单侧探查术.结果 本组无手术死亡,无切口感染及喉返神经损伤等并发症.围手术期1例患者血钙低于正常范围,发生手足搐搦,静脉注射钙剂3 d后症状缓解.3例患者仅出现轻微的口唇及手足麻木感,但血钙在正常范围,口服补钙后缓解.术后平均住院时间6.5 d.4例获得随访,随访时间2个月～2年,血钙及血PTH均在正常范围.结论 无症状PHPT患者早期手术效果好,对于定位诊断明确的PHPT患者应该行手术治疗,定位不明确的或不适合手术的患者可行保守疗法.     

原发性甲状旁腺功能亢进症的诊断和外科治疗

目的 总结原发性甲状旁腺功能亢进症的诊治经验.方法 回顾性分析1992年11月-2008年12月我院收治的91例原发性甲状旁腺功能亢进症(primary hyperparathyroidism,PHPT)的临床资料.结果 91例患者中甲状旁腺腺瘤88例(96.7%),腺癌3例(3.3%).血清钙和甲状旁腺素(PTH)均升高.主要表现为骨痛和泌尿系结石.术前B超、CT和ECT99mTc-MIBI定位准确率分别为83.5%(76/91)、60.9%(14/23)、98.6%(69/70).全部病例均行甲状旁腺腺瘤切除术,1例腺癌另行甲状腺腺叶切除加中央区淋巴结清扫.一次手术成功率97.8%(89/91).90例术后随访8个月至14年,87例腺瘤患者获得临床治愈,3例腺癌患者中2例复发,其中1例死亡.结论 原发性甲状旁腺功能亢进症的诊断并不困难,患有慢性骨病、反复发作泌尿系结石、消化性溃疡的患者应作为此病疑诊对象,血钙检查应作为常规;术前影像学检查首选B超和ECT~(99m)Tc-MIBI;定位准确的甲状旁腺瘤采用腺瘤切除术是可行的.     

73例原发性甲状旁腺功能亢进症的诊治分析

目的总结原发性甲状旁腺功能亢进症的诊治体会。方法回顾性分析2003年1月至2010年12月期间笔者所在医院施行手术治疗的73例原发性甲状旁腺功能亢进症患者的临床资料。结果 73例原发性甲状旁腺功能亢进症患者中,腺体增生1例（1.4%）,腺瘤67例（91.8%）,腺癌5例（6.8%）。临床表现包括骨和关节疼痛63例（86.3%）、病理性骨折17例（23.3%）、骨质疏松59例（80.8%）、乏力28例（38.4%）、腹痛4例（5.5%）、泌尿系统结石17例（23.3%）、恶性高血压1例（1.4%,为多发性内分泌腺瘤病Ⅱa型）等。术前所有患者的全段甲状旁腺激素水平均升高,有80.8%（59/73）的患者血钙水平升高,有84.9%（62/73）的患者碱性磷酸酶水平升高。病灶检出率彩超为82.8%（53/64）,CT检查为83.3%（20/24）,99Tcm-司他比锝（MIBI）核素扫描为90.2%（46/51）,三者联合检查为91.8%（67/73）,余6例病灶术前未能明确定位。所有病例均行患侧甲状旁腺切除术,5例腺癌病例加行颈淋巴结清扫术。术后发生手足抽搐16例,声音嘶哑2例,急性胰腺炎1例,急性左心功能衰竭1例。术后69例患者获访,随访时间3～72个月,平均17.3个月。随访期间,大部分病例于术后1个月内其骨痛（43例）和乏力（18例）症状改善,但甲状旁腺激素和血钙水平的恢复则相对缓慢。1例腺瘤病例术后复发,1例腺癌病例术后发生肺转移,1例腺癌病例于术后37个月因肺和骨转移死亡,其余患者（1例腺癌病例由腺瘤恶变而来,行再次手术）至随访结束时均存活,无复发及转移。结论应深入理解和认识原发性甲状旁腺功能亢进症的临床特点,甲状旁腺功能和血钙水平的筛查有助于该病的检出。甲状旁腺切除术是该病的有效治疗手段,术前准确定位有助于缩小探查范围。     

Primärer Hyperparathyreoidismus

Introduction

Normocalcemic hyperparathyrinemia, i.e. elevated parathyroid hormone (PTH) levels after parathyroidectomy in patients with primary hyperparathyroidism (pHPT) may occur in the course of postoperative recovery without the development of persistence or relapse.

Materials, methods and results

Intraoperative and long-term (7 year) postoperative PTH and calcium levels after curative parathyroidectomy are demonstrated on the basis of a case report of a 62-year-old female patient with severe pHPT and pronounced osseous and renal manifestations. The intraoperative PTH gradient displayed a decrease from 1072 pg/ml to 13 pg/ml (normal range 11–67 pg/ml) followed by an increase of up to 287pg/ml. The hyperparathyoid values decline to subnormal levels on administration of calcium and vitamin D and increase again after tapering these medications. The inverse calcium/PTH correlation in the course of the 7-year observation period suggests an intact feed-back mechanism. Preoperative PTH screening was performed in 316 consecutive normocalcemic thyroid patients to evaluate the rate of incidental hyperparathyroidism in patients with normal serum calcium levels. Of these patients 31 (9.8%) with normocalcemia (average 2.28 mmol/l, normal range 2.1–2.7 mmol/l) exhibited increased PTH levels averaging 84.2 pg/ml. A parathyroid adenoma was found intraoperatively as the cause for normocalcemic pHPT in only 1 of these 31 patients.

Discussion and conclusions

A review of the literature revealed that late postoperative elevated parathyroid hormone levels after successful pHPT surgery occur in 21.5%. Multiple causes are discussed, e.g. reactive hyperparathyroidism in cases of relative hypocalcemia, hungry bone syndrome, vitamin D deficiency, renal dysfunction and ethnic or lifestyle differences. In mild cases of postoperative hyperparathyrinemia observation of the patient may be sufficient. In cases of reactive hyperparathyroidism due to hypocalcemia, administration of calcium is indicated, in symptomatic patients, additional administration of vitamin D or calcitriol is necessary. Vitamin D deficiency per se needs adequate substitution. In cases of ongoing hyperparathyrinemia an interdisciplinary diagnostic and therapeutic approach is required.     

Total Parathyroidectomy Without Autotransplantation for Renal Hyperparathyroidism: Experience with a qPTH-controlled Protocol

Background Controversy regarding the optimal surgical treatment for secondary hyperparathyroidism (sHPT) continues. Subtotal parathyroidectomy (PTX) with a small remnant and total parathyroidectomy with autotransplantation prevail, although impaired by considerable recurrence rates. Concerns about postoperative management and long-term supplementation prevent broader acceptance of total parathyroidectomy without autotransplantation. Materials and Methods The standardized surgical procedure with intraoperative PTH assessment (qPTH) included cervical thymectomy, histological proof of four parathyroid specimens and obligatory cryopreservation of parathyroid tissue in all 23 patients undergoing total PTX without autotransplantation. Whenever qPTH did not normalize, complete cervical exploration of ectopic sites was performed. Another 64 patients with subtotal PTX for sHPT served as comparison for the postoperative course. Results There were 13 primary and 10 completion (5 persistent, 5 recurrent sHPT) total PTX with 14 concurrent thyroid resections performed. Mean preoperative PTH was 1.351 pg/ml (12–72 pg/ml) and serum calcium was 2.5 mmol/l (2.25–2.5 mmol/l). PTH showed intraoperative normalization in 15 patients and a 50% PTH reduction from preoperative values in all. Postoperative course was not significantly different from the subtotal PTX group and showed PTH within the normal range for 5 patients (4 < 35 pg/ml), 7 with PTH < 12 pg/ml, and 4 without measurable PTH. In 4 patients PTH did not normalize postoperatively. Serum calcium levels were below normal in all patients: < 2.25 mmol/l in 9, < 2.00 mmol/l in 7, and <1.8 mmol/l in 6 patients. Only 1 patient required intermittent early postoperative i.v. calcium supplementation, 6 patients received oral calcium and vitamin D supplement for low calcium levels, but no severe hypocalcemic symptoms were encountered. Mean postoperative hospital stay was 5 days. No recurrent laryngeal nerve palsies were encountered. Complications were two cervical bleedings following postoperative hemodialysis requiring evacuation. Conclusions Total PTX without autotransplantation proves to be an equally safe and successful procedure for sHPT as subtotal PTX or total PTX with autotransplantation. Measurable PTH after total PTX as demonstrated in this study, supports the idea of uncontrollable isolated cell nests that are inevitably prone to stimulated growth with time. Therefore, total PTX is superior with regard to prevention of recurrence. Adequate supplementation with calcium and vitamin D, often necessary after subtotal PTX to suppress inadequate PTH and protect from recurrence, will prevent severe hypocalcemia and with the modern aluminium-diminishing dialysis regimen, development of adynamic bone disease appears less likely than feared. If necessary, cryopreserved parathyroid tissue can be autotransplanted on demand.     

Reelevation of parathyroid hormone level after parathyroidectomy in patients with primary hyperparathyroidism: importance of decreased renal parathyroid hormone sensitivity

BACKGROUND: We hypothesized that impaired peripheral sensitivity to parathyroid hormone (PTH) may play a role in reelevation of PTH after successful operation for primary hyperparathyroidism (pHPT). METHODS: Factors affecting reelevation of PTH were determined in 90 patients who underwent parathyroidectomy for pHPT. PTH/nephrogenous cyclic adenosine monophosphate ratio, as an index of renal resistance to PTH, was examined in relation to factors shown to influence reelevation of PTH. RESULTS: Serum PTH levels were elevated above the upper limit of normal in 23 patients (26%) at 1 week and in 39 patients (43%) at 1 month after parathyroidectomy. These 39 normocalcemic patients with elevated serum PTH at 1 month after parathyroidectomy had a higher preoperative serum level of PTH and lower serum phosphate and 25-hydroxyvitamin D (25OHD) concentrations than those with normal PTH (n = 59). Elevated PTH and low 25OHD were shown by multivariate analysis to be significant predictors of reelevation of PTH. Renal resistance to PTH was higher in patients with vitamin D deficiency or renal insufficiency than in patients with normal serum vitamin D concentrations or normal renal function, and it increased according to increases in levels of PTH. CONCLUSIONS: The mechanism of PTH reelevation in patients with pHPT after successful parathyroidectomy appears to be renal resistance to PTH.     

Surgical Treatment of Patients with Mildly Elevated Parathormone and Calcium Levels

Background

Patients with mildly elevated parathormone (PTH) and calcium levels consistent for primary hyperparathyroidism (pHPT) may present with more underlying multiglandular disease (MGD) and higher operative failure and recurrence rates than those with conventional, or “classic” pHPT. This study compared the clinical characteristics and surgical outcomes of patients with biochemically mild versus conventional pHPT.

Methods

A series of 707 consecutive patients underwent initial targeted parathyroidectomy with intraoperative parathormone monitoring (IPM) at a single institution. Biochemically mild (BM) pHPT was defined as PTH > 65 and <100 pg/ml with serum calcium >10.4 and <11 mg/dl. Conventional pHPT was defined as calcium ≥11 mg/dl and PTH ≥ 100 pg/ml. Prospectively collected data for all patients, including operative indication, preoperative laboratory values, imaging, IPM dynamics, and postoperative laboratory values were retrospectively reviewed. Additional assessments included presence of MGD, bilateral neck exploration (BNE), single-gland volume, and operative failure or success, and recurrence.

Results

Of 60 patients with BM-pHPT, 46 reported preoperative bone pain, kidney stones, fatigue, and/or mental disturbances. The remaining 14 BM-pHPT patients underwent parathyroidectomy based on published asymptomatic guidelines. Patients with BM-pHPT had significantly more kidney stones, MGD, and BNE. Average single-gland volume and postoperative PTH levels were significantly lower in BM-pHPT patients. There were no significant differences between groups regarding preoperative localization accuracy, IPM dynamics, or operative success/failure, recurrence rates.

Conclusions

BM-pHPT patients had more MGD requiring BNE but achieved operative success rates similar to those of patients with conventional disease. IPM successfully identifies MGD in BM-pHPT patients, who should be counseled regarding more extensive operations than limited parathyroidectomy.     

Primary hyperparathyroidism revisited in menopausal women with serum calcium in the upper normal range at population-based screening 8 years ago

Population-based screening showed 2.1% prevalence of primary hyperparathyroidism (pHPT) in postmenopausal women. Individuals with total serum (s)-calcium levels of 2.55 mmol/L or more at screening were diagnosed with pHPT when subsequent analysis supported inappropriately elevated intact parathormone (PTH) levels in relation to even normal s-calcium levels. The arbitrary diagnostic criteria were validated by parathyroidectomy. Herein we reinvestigated biochemical signs of pHPT in women not diagnosed with pHPT due to s-calcium 2.50 to 2.54 mmol/L (group A, n = 160) at screening or due to appropriate PTH levels on two occasions after screening (group B, n = 70). Altogether, 99 women in group A and 47 in group B underwent reinvestigation 8.8 years after screening when they were 65 to 84 years old. The s-calcium levels averaged 2.56 mmol/L and had increased in group A (mean 0.04 mmol/L) and decreased in group B (mean 0.05 mmol/L). A total of 48 and 18 females (48%, 38%), respectively, met the previously validated criteria of pHPT. Altogether 21% of them were hypercalcemic (range 2.60–3.12 mmol/L). Subgroup analysis showed that PTH had not increased with time (n = 47) and that atherogenic blood lipids, but not glucose levels, were similar in pHPT patients and matched controls (n = 37). Assuming the existence of pHPT already at screening, the prevalence of pHPT could be adjusted to 3.4%. Even the most liberal diagnostic criteria utilized at pHPT screening seemed to underdiagnose the disease by inefficient cutoff limits for s-calcium and PTH. Because one-fifth of the women with pHPT progressed to hypercalcemia, long-term follow-up is advocated for those with s-calcium in the upper normal range.     

Persistent Hypocalcemia with Elevated Parathyroid Hormone Levels After Long-Term Primary Hyperparathyroidism: Report of a Case

We report herein the case of a 48-year-old man with long-term persistent primary hyperparathyroidism (pHPT) despite undergoing a parathyroidectomy in 1976, followed by a reoperation in 1978, for whom resection of a parathyroid adenoma in the upper mediastinum was eventually performed. His postoperative course was complicated by recurrent hypocalcemia refractory to oral calcium substitution and significantly elevated levels of parathyroid hormone (PTH). The radiological findings are presented, and we discuss the possible reasons for the coincidence of severe hypocalcemia with increased PTH levels in association with pHPT. Received: October 18, 1999 / Accepted: May 30, 2000     

Outpatient parathyroidectomy in the pediatric population: An 18-year experience

BackgroundParathyroidectomy for primary hyperparathyroidism (pHPT) is safely performed in the outpatient setting in the adult population. However, concern that children and adolescents have higher complication rates and are unable to recognize and communicate symptoms of hypocalcemia has limited same-day discharges in the pediatric population.MethodsNineteen patients aged 8–18 years (14.1 ± 0.7) underwent outpatient parathyroidectomy for pHPT by a single high-volume endocrine surgeon from 2002–2020. Patient demographics, disease, operations, and complications were reviewed.ResultsSixteen of 19 patients were symptomatic with fatigue (62.5%), joint pain (37.5%) and nephrolithiasis (18.7%) most common. Mean preoperative Ca and PTH were 11.7 ± 0.3 mg/dL and 102.3 ± 11.8pg/mL, respectively. Ten of 19 had a single adenoma and 9 had multigland hyperplasia including one MEN1 and one MEN2A patient. We performed 11 four-gland explorations, 8 unilateral parathyroidectomies; including 9 transcervical thymectomies, 1 total thyroidectomy, and 1 bilateral central neck dissection. Mean 6-month postoperative Ca and PTH levels were 9.5 ± 0.3 mg/dL (range 7.3–10.3) and 29±5.0pg/mL (range 6.3–77), respectively. One patient developed permanent hypoparathyroidism and 1 had temporary hypocalcemia. No temporary or permanent hoarseness, unplanned same-day admission, wound complications, or Emergency Department visits occurred.ConclusionOutpatient parathyroidectomy can be safely and effectively performed in pediatric patients with primary HPT.Level of EvidenceTreatment Study, Level III.     

Factors predictive of critical value of hypocalcemia after total parathyroidectomy without autotransplantation in patients with secondary hyperparathyroidism

Background: Severe hypocalcemia is the most dangerous complication occurring after total parathyroidectomy without autotransplantation (TPTX) for secondary hyperparathyroidism (SHPT). We aim to identify the prevalence and potential risk factors of very severe hypocalcemia in patients with SHPT undergoing TPTX.

Methods: From April 2012 to August 2015, 157 patients with SHPT undergoing TPTX were reviewed. The critical value of hypocalcemia (CVH) was postoperative serum Ca²⁺ levels of ≤1.5?mmol/L.

Results: Univariate analysis showed that patients in the CVH group were significantly younger than those in the non-CVH group. Sex ratio was significantly different between the two groups. The CVH group had significantly higher levels of preoperative PTH and ALP. Male sex and preoperative levels of PTH and ALP were significant independent risk factors by logistic regression analysis.

Conclusions: Male sex, preoperative PTH and ALP were significantly associated with CVH in patients with SHPT undergoing TPTX.     

The role of parathyroid hormone measurements after surgery for primary hyperparathyroidism

BACKGROUND: During parathyroidectomy for primary hyperparathyroidism (pHPT), intraoperative parathyroid hormone (IOPTH) levels are used to confirm removal of all hyperfunctioning parathyroid tissue. The phenomenon of elevated parathyroid hormone (PTH) levels with normocalcemia after curative parathyroidectomy, seen in up to 40% of patients, continues to be an unexpected and unexplained finding. We therefore investigated whether postoperative PTH levels are as reliable as IOPTH levels in predicting cure after surgery for pHPT. METHODS: We reviewed our prospective database of consecutive patients undergoing surgery for pHPT between December 1999 and November 2004. Curative parathyroidectomy was defined as normocalcemia 6 months or longer postoperatively. RESULTS: A total of 328 patients who underwent 330 operations for pHPT had IOPTH measurements and serum follow-up calcium levels at 6 months or longer. Surgery was curative in 315 (95.5%) operations. IOPTH levels correctly predicted operative success in 98.2% (positive predictive value [PPV]. Postoperatively, the PPV of a normal PTH level at 1 week, 3 months, and 6 months was 97.1%, 97.3%, and 96.5%, respectively. Of all patients with an elevated postoperative PTH level at 1 week, 3 months, or 6 months, only 13.7%, 14.3%, and 14%, respectively, were not cured. CONCLUSIONS: Normal postoperative PTH levels reliably predict operative success. However, they do not improve upon results predicted by IOPTH levels. Elevated postoperative PTH levels do not predict operative failure in most patients. We propose that PTH measurements after surgery for pHPT may be misleading, costly, and not indicated in normocalcemic patients.     

Preoperative Normal Level of Parathyroid Hormone Signifies an Early and Mild Form of Primary Hyperparathyroidism

Abstract Contemporary patients are often diagnosed with mild or intermittent hypercalcemia. In addition, most studies demonstrate patients with parathyroid (PTH) levels in the upper normal range. The aim of the present investigation was to define subgroups of patients with mild primary hyperparathyroidism (pHPT), which could be of importance in the decision for or against surgical treatment. Two-hundred and eleven patients, operated for pHPT were investigated with biochemical variables known to reflect PTH activity, renal function, and bone mineral content. The preoperative diagnosis of pHPT was based on the presence of hypercalcemia combined with an inappropriate serum concentration of PTH. The mean age of the patients was 64 ± 14 years and the mean serum level of calcium was 2.78 ± 0.19 mmol/L. One hundred and sixty-two patients (77%) had raised levels of calcium and PTH the day before surgery (overt pHPT), 25 patients (12%) had a normal level of calcium and a raised PTH level (normal calcium group), and 20 patients (9%) had a raised level of calcium and a normal level of PTH (normal PTH group). In four patients the level of calcium and PTH was normal. Between-group analysis demonstrated no major difference in symptom and signs of pHPT. Except for lower adenoma weight, patients in the normal calcium group did not essentially differ from the patients in the overt pHPT group. However, patients in the normal PTH group were a decade younger, and had better renal function, lower bone turnover, and a preserved bone density compared with patients in the overt pHPT group. In conclusion, the data from the present investigation show that pHPT patients with a preoperative normal PTH level have an early and mild form of the disease. Furthermore, the serum calcium concentration does not reflect disease severity in pHPT.