Intraoperative parathyroid hormone measurement in patients with secondary hyperparathyroidism.
OBJECTIVE
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.


METHODS
Case series from August 1 to December 31, 2000.


METHODS
Tertiary referral center.


METHODS
Patients with symptomatic secondary hyperparathyroidism (n = 24) who underwent total parathyroidectomy and autotransplantation were included in the study.


METHODS
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.


METHODS
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.
Chou
Fong-Fu
FF
Department of Surgery, Chang Gung Memorial Hospital at Kaoshiung, 123 Ta-Pei Rd, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan. choulu@ms4.hinet.net
Lee
Chiang-Hsuen
CH
Chen
Jin-Bor
JB
Hsu
Kuo-Tai
KT
Sheen-Chen
Shyr-Ming
SM
D000469:Alkaline Phosphatase / Q000097:blood; D002118:Calcium / Q000097:blood; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000601:surgery*; D016343:Monitoring, Intraoperative / Q000379:methods; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D010710:Phosphates / Q000097:blood; D013997:Time Factors
D010281:Parathyroid Hormone; D010710:Phosphates; D000469:Alkaline Phosphatase; D002118:Calcium