To autotransplant simultaneously or not -- can intraoperative parathyroid hormone monitoring reliably predict early postoperative parathyroid hormone levels after total parathyroidectomy for hyperplasia?
BACKGROUND
Intraoperative parathyroid hormone (IOPTH) monitoring is well-established in operation for primary hyperparathyroidism (HPT). In diseases where total parathyroidectomy (tPx) is a treatment option its reliability to predict postoperative residual parathyroid hormone (PTH) remains in question.


METHODS
Thirty-eight consecutive patients with tPx due to secondary autonomous renal (26 patients), familial (8 patients), or lithium-induced (4 patients) HPT were analyzed retrospectively for the relationship between IOPTH and postoperative PTH. Three concepts were tested to predict a postoperative PTH below the normal range: a mandatory intraoperative decline of PTH less than 50% and 90% of the baseline value as well as an intraoperative decline below a threshold of 100 pg/ml 10 minutes after tPx.


RESULTS
There was no significant correlation between IOPTH decline and postoperative PTH (R = .265; P = .108). In patients with a 4-gland resection (n = 34) the positive predictive value was 62.5% and the sensitivity was 90.9% for the '50% concept.' The corresponding values were 68.8% and 50.0% for the '90% concept,' and 81.8% and 81.8% for the '100 pg/ml concept.'


CONCLUSIONS
The decision for simultaneous autotransplantation after tPx can not be based on IOPTH monitoring, because the reliability in prediction of early postoperative PTH status is insufficient.
Müller-Stich
Beat P
BP
Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
Brändle
Michael
M
Binet
Isabelle
I
Warschkow
Rene
R
Lange
Jochen
J
Clerici
Thomas
T
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006962:Hyperparathyroidism, Secondary / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D010280:Parathyroid Glands / Q000637:transplantation; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014182:Transplantation, Autologous
C470125:PTH protein, human; D010281:Parathyroid Hormone