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Carmen C. Solorzano, MD; William Mendez, MD; John I. Lew, MD; Steven E. Rodgers, MD, PhD; Raquel Montano, BS; Denise M. Carneiro-Pla, MD; George L. Irvin III, MD

Arch Surg. 2008;143(7):659-663.

Hypothesis  Untreated long-term elevated parathyroid hormone (PTH) levels after successful parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear.

Design  Retrospective case series.

Setting  Tertiary referral center.

Patients  Five hundred seventy-six consecutive patients with HPT.

Intervention  Parathyroidectomy guided by intraoperative monitoring of PTH levels.

Main Outcome Measures  Overall incidence of elevated PTH levels (measurements of  70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after parathyroidectomy).

Results  Of the 505 patients who underwent successful parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7%) consistently had PTH levels within the reference range, and 168 (33.3%) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8%) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency.

Conclusion  Although one-third of the patients had elevated PTH levels after successful parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia.

Author Affiliations: Division of Endocrine Surgery, DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida (Drs Solorzano, Mendez, Lew, Rodgers, and Irvin and Ms Montano); and Departments of Surgery, University of Puerto Rico School of Medicine, San Juan (Dr Mendez) and Medical University of South Carolina, Charleston (Dr Carneiro-Pla).

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RELATED LETTERS

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism
Jirí Sedy
Arch Surg. 2009;144(1):92-93.
EXTRACT | FULL TEXT  

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism—Reply
John I. Lew and Carmen C. Solorzano
Arch Surg. 2009;144(1):93.
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THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism--Reply
Lew and Solorzano
Arch Surg 2009;144:93-93.
FULL TEXT  

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism
Sedy
Arch Surg 2009;144:92-93.
FULL TEXT