Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism
✍ Scribed by Melih Kara; Gurkan Tellioglu; Ugur Bugan; Osman Krand; Ibrahim Berber; Pinar Seymen; Pinar Ata Eren; Leyla Ozel; Izzet Titiz
- Publisher
- John Wiley and Sons
- Year
- 2010
- Tongue
- English
- Weight
- 593 KB
- Volume
- 120
- Category
- Article
- ISSN
- 0023-852X
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✦ Synopsis
Abstract
Objectives/Background:
The aim of this study is to investigate the predictive value of intraoperative parathormone measurement addressing successful surgical resection in patients with secondary hyperparathyroidism.
Methods:
The study included 42 consecutive patients operated on between May 2006 and July 2008. Patients were grouped according to successful surgery (Group 1, n = 36) and persistent postoperative hyperparathyroidism (Group 2, n = 6). Serum phosphorus (P), total calcium (tCa), ionized calcium (iCa), intact parathormone (iPTH), and alkaline phosphatase (ALP) were drawn preoperatively and intraoperatively upon 15 minutes after completion of resection (iPTH~15~). The rate of decrease of pith detected by iPTH~15~ compared to preoperative values was calculated (iPTH~%~).
Results:
Preoperative P, tCa, iCa, iPTH, and ALP were comparable. Subtotal parathyroidectomy (sPx) (n = 27) and total parathyroidectomy with autotransplantation (tPx) (n = 15) were performed. Mean iPTH~15~ value, iPTH~%~ rates were 145.9 ± 12.3 pg/mL, % 91.6 ± 0.7, and 522.5 ± 85.4 pg/mL, % 75.1 ± 2.0 (P = ,001) in Groups 1 and 2, respectively. Mean serum tCa and iCa at POD#1 in Group 1 were 7.6 ± 0.1 mg/dL, 0.910 ± 0.4 mmol/L, and Group 2 were 8.3 ± 0.3 mg/dL, 1.050 ± 0.4 mmol/L (P < .05), respectively. ALP levels were similar.
Conclusion:
iPTH~15~ value and iPTH~%~ rate accurately predicts the completeness of resection in secondary hyperparathyroidism. The rate of decrease in serum iPTH detected intraoperatively compared to preoperative baseline levels exceeding 90% in sPx, 95% in tPx, accurately predicts the success of surgery. Postoperative normocalcemia without calcium replacement would raise a suspicion about completeness of surgical resection. Laryngoscope, 2010