Intraoperative PTH: effect of sample timing and vitamin D status.
OBJECTIVE
To assess the effect of timing of intraoperative parathormone (iPTH) samples and 25-hydroxyvitamin D (25-OHD) status on decision-making during parathyroidectomy.


METHODS
A total of 77 patients with primary hyperparathyroidism and iPTH levels (preincision, preremoval, 5 (T5) and 10 (T10) minutes postremoval) performed during parathyroidectomy were reviewed.


RESULTS
Forty-one percent of patients were 25-OHD insufficient. We noted a significant correlation between preoperative 25-OHD and preincision iPTH (P=0.002) but not iPTH at postremoval levels (T5, P=0.89; T10, P=0.42). When compared with preincision iPTH, the use of either the higher preincision or preremoval iPTH baseline significantly improves the assay sensitivity from 83% to 93% at T5 (P=0.01) and 87% to 97% at T10 (P=0.02). Surgical cure was obtained in 98% of patients.


CONCLUSIONS
Obtaining preremoval iPTH allowed earlier decision with respect to operative completion in 38% of cases. 25-OHD status does not appear to significantly affect interpretation of iPTH levels.


CONCLUSIONS
Obtaining both baseline levels significantly improves sensitivity in iPTH monitoring.
Statham
Melissa McCarty
MM
Department of Otolaryngology-Head and Neck Surgery, University of Cincinnati School of Medicine, Cincinnati, OH, USA.
Watts
Nelson B
NB
Steward
David L
DL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011379:Prognosis; D012307:Risk Factors; D014807:Vitamin D / Q000031:analogs & derivatives* / Q000097:blood; D014808:Vitamin D Deficiency / Q000097:blood / Q000601:surgery
D010281:Parathyroid Hormone; D014807:Vitamin D; C104450:25-hydroxyvitamin D