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Intraoperative Parathyroid Hormone Measurement in Patients With Secondary Hyperparathyroidism
Fong-Fu Chou, MD;
Chiang-Hsuen Lee, MD;
Jin-Bor Chen, MD;
Kuo-Tai Hsu, MD;
Shyr-Ming Sheen-Chen, MD
Arch Surg. 2002;137:341-344.
Hypothesis Secondary hyperparathyroidism decreases renal clearance of parathyroid hormone (PTH).
Objective To determine whether rapid PTH assays can be used to predict the success of a total parathyroidectomy to treat symptomatic secondary hyperparathyroidism.
Design Case series from August 1 to December 31, 2000.
Setting Tertiary referral center.
Participants Patients with symptomatic secondary hyperparathyroidism (n = 24) who underwent total parathyroidectomy and autotransplantation were included in the study.
Interventions Blood samples for rapid PTH analyses were drawn from an indwelling catheter at the induction of anesthesia (baseline) and before (0 minutes), 10 minutes, and 30 minutes after the removal of the last parathyroid gland. Regular intact PTH (iPTH) assays were conducted later.
Main Outcome Measure If a patient's regular iPTH levels were below 65 pg/mL at 1 week or 3 months postoperatively, the operation was considered successful.
Results All 24 patients had successful operations. Rapid PTH and regular iPTH correlated significantly at 0, 10, and 30 minutes. Rapid PTH levels decreased significantly at each time period and were 176 ± 40.9 pg/mL (mean ± SE) at 10 minutes. The percentage decrease in rapid PTH levels was 39.5% ± 12.7% at 0 minutes, 75.1% ± 6.2% at 10 minutes, and 91.0% ± 0.1% at 30 minutes (mean ± SE). A decrease of 60% or more from baseline PTH levels at 10 minutes and/or a decrease of 85% or more at 30 minutes predicted the successful removal of all parathyroid glands.
Conclusions A drop in PTH levels is delayed until 30 minutes after total parathyroidectomy; however, a rapid PTH assay 10 minutes after the removal of the last parathyroid gland is as accurate as an assay performed at 30 minutes postoperatively. Intraoperative PTH monitoring demonstrates relevant decreases in rapid PTH levels after parathyroidectomy that are similar to those previously documented in patients with primary hyperparathyroidism.
From the Departments of Surgery (Drs Chou and Sheen-Chen), Nuclear Medicine (Dr Lee), and Nephrology (Drs Chen and Hsu), Chang Gung Memorial Hospital, Chang Gung University, Kaohsiung Hsien, Taiwan.
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