Elevated serum parathormone level after "concise parathyroidectomy" for primary sporadic hyperparathyroidism.
BACKGROUND
Cure after parathyroid exploration is traditionally assessed by serum calcium concentration 6 months postoperatively. Postoperative normocalcemic elevation of serum parathormone (PTH) level has been described but is of unclear significance.


METHODS
In a 6-year prospective study of outcomes in 380 patients undergoing initial parathyroidectomy for primary sporadic hyperparathyroidism, we measured intact serum PTH and calcium levels at more than 5 months. Those with normocalcemic high PTH levels were begun on oral calcium + vitamin supplements and monitored.


RESULTS
At more than 5 months postoperatively, normocalcemic elevation in serum PTH level occurred in 28% of patients, was more common after resection of double adenomas (P =.01), and predated the onset of recurrent hypercalcemia in 3 of 3 patients with unrecognized multiglandular disease. Although delayed treatment with calcium and vitamin supplements produced no clear benefit, patients who took such supplements from the date of surgery were much less likely to have an elevated serum PTH level more than 5 months later (P =.0005).


CONCLUSIONS
After successful parathyroid surgery, compensatory normocalcemic elevation in serum PTH level is frequent and may arise from dietary deficiency. Monitored supplemental intake of calcium and vitamin D appears to prevent or to normalize the condition in most patients. Patients with normocalcemic elevation in serum PTH level should receive evaluation for dietary deficiencies as well as follow-up for possible residual disease.
Carty
Sally E
SE
Departments of Surgery, University of Pittsburgh School of Medicine, 497 Scaife Hall, Pittsburgh, PA 15261, USA.
Roberts
Michelle M
MM
Virji
Mohamed A
MA
Haywood
Laura
L
Yim
John H
JH
D000236:Adenoma / Q000097:blood / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000008:administration & dosage / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D010282:Parathyroid Neoplasms / Q000097:blood / Q000601:surgery; D016105:Parathyroidectomy / Q000379:methods*; D011183:Postoperative Complications; D011446:Prospective Studies; D014807:Vitamin D / Q000008:administration & dosage
D010281:Parathyroid Hormone; D014807:Vitamin D; D002118:Calcium