title: To autotransplant simultaneously or not -- can intraoperative parathyroid hormone monitoring reliably predict early postoperative parathyroid hormone levels after total parathyroidectomy for hyperplasia?
abstract: 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.
authors.affiliation: Department of Surgery, Kantonsspital St Gallen, St Gallen, Switzerland.
authors.forename: Beat P
authors.initials: BP
authors.lastname: Müller-Stich
authors.forename: Michael
authors.initials: M
authors.lastname: Brändle
authors.forename: Isabelle
authors.initials: I
authors.lastname: Binet
authors.forename: Rene
authors.initials: R
authors.lastname: Warschkow
authors.forename: Jochen
authors.initials: J
authors.lastname: Lange
authors.forename: Thomas
authors.initials: T
authors.lastname: Clerici
mesh_terms: 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
chemical_list: C470125:PTH protein, human; D010281:Parathyroid Hormone