title: Long-term outcome of patients with intraoperative parathyroid level remaining above the normal range during parathyroidectomy.
abstract: BACKGROUND
  Criterion requiring intraoperative parathyroid hormone (IOPTH) drops >50% from the highest, preincision or preexcision level, 10 minutes after the abnormal gland's excision predicts operative success with 98% accuracy. The purpose of this study is to correlate IOPTH dynamics with recurrent hyperparathyroidism (RecHPT) and eucalcemia with high PTH (HPTH).
  
  
  METHODS
  We followed 383 consecutive patients with parathyroidectomy guided by IOPTH monitoring using the above criterion for >6 months. Calcium and PTH levels were measured for 50 months (range, 6-173). Patients were divided in 2 groups: group 1 comprised 302 participants with IOPTH levels that decrease to the normal range (NR), and group 2, with 81 participants who had >50% IOPTH decrease but remained above the normal range. The incidence of RecHPT and eucalcemia with HPTH was evaluated.
  
  
  RESULTS
  RecHPT was found in 2% (8/383) of patients and eucalcemia with HPTH was present in 19% (74/383). In group 1, 17% (52/302) had eucalcemia with HPTH, whereas in group 2, this incidence was 27% (22/81; P = .04). However, only 2% of those (6/302) in group 1 and 2.5% (2/81) in group 2 developed RecHPT (P = .76). Conversely, 70.5% of those (57/81) in group 2 were eucalcemic with normal PTH.
  
  
  CONCLUSIONS
  Although postoperative eucalcemia with HPTH was significantly higher among patients with IOPTH above the normal range than in patients in group 1, the incidence of RecHPT was not increased. The majority of patients in whom IOPTH did not drop to the normal range continue to be biochemically normal after the operation.
authors.affiliation: Department of Surgery, Medical University of South Carolina, Charleston, SC, USA. carneiro@musc.edu
authors.forename: Denise M
authors.initials: DM
authors.lastname: Carneiro-Pla
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Solorzano
authors.forename: John I
authors.initials: JI
authors.lastname: Lew
authors.forename: George L
authors.initials: GL
authors.lastname: Irvin
mesh_terms: D002118:Calcium / Q000097:blood*; D006801:Humans; D006961:Hyperparathyroidism / Q000097:blood* / Q000601:surgery*; D007430:Intraoperative Care; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D012008:Recurrence; D012189:Retrospective Studies; D016896:Treatment Outcome
chemical_list: D010281:Parathyroid Hormone; D002118:Calcium