Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism.
OBJECTIVE
Untreated long-term elevated parathyroid hormone (PTH) levels after successful parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear.


METHODS
Retrospective case series.


METHODS
Tertiary referral center.


METHODS
Five hundred seventy-six consecutive patients with HPT.


METHODS
Parathyroidectomy guided by intraoperative monitoring of PTH levels.


METHODS
Overall incidence of elevated PTH levels (measurements of >or= 70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after parathyroidectomy).


RESULTS
Of the 505 patients who underwent successful parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7%) consistently had PTH levels within the reference range, and 168 (33.3%) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8%) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency.


CONCLUSIONS
Although one-third of the patients had elevated PTH levels after successful parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia.
Solorzano
Carmen C
CC
Division of Endocrine Surgery, Department of Surgery, DeWitt Daughtry Family, University of Miami Miller School of Medicine, Miami, Florida 33136, USA. csolorzano@med.miami.edu
Mendez
William
W
Lew
John I
JI
Rodgers
Steven E
SE
Montano
Raquel
R
Carneiro-Pla
Denise M
DM
Irvin
George L
GL
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002118:Calcium / Q000097:blood; D005260:Female; D006801:Humans; D006961:Hyperparathyroidism / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011184:Postoperative Period; D012008:Recurrence; D012189:Retrospective Studies
D010281:Parathyroid Hormone; D002118:Calcium