What is the clinical significance of an elevated parathyroid hormone level after curative surgery for primary hyperparathyroidism?
OBJECTIVE
Recent reports have demonstrated that between 8%-40% of patients after curative surgery for primary hyperparathyroidism (HPT) have an elevated parathyroid hormone level (ePTH). To determine the clinical significance of ePTH and if it is a potential risk factor for recurrent HPT, we reviewed our experience.


METHODS
611 consecutive patients underwent curative parathyroidectomy for primary HPT by one surgeon. Patients with ePTH [defined as postoperative parathyroid hormone (PTH) levels > or = 65 pg/mL at least 1 week after surgery with normal calcium levels] were compared with those with normal PTH.


RESULTS
ePTH occurred in 111/611 (18.2%) patients. When compared with those with normal PTH, ePTH patients were older and had higher preoperative PTH and alkaline phosphatase levels (P < 0.05). Importantly, recurrent HPT was significantly higher in patients with ePTH (5.4% versus 1.2%, P < 0.05). Further analysis of the ePTH patients revealed that serum calcium 1-week after surgery was predictive of recurrent HPT. In ePTH patients with postoperative calcium > or = 9.7 mg/dL, the recurrence rate was 16% compared with 0% in those whose calcium was < 9.7 mg/dL.


CONCLUSIONS
Most of patients (95%) with ePTH after curative parathyroidectomy for primary HPT will not develop recurrent HPT. However, recurrent disease is significantly more common among patients with ePTH and was always associated with postoperative calcium > or = 9.7 mg/dL. Thus, these data suggest that streamlining postoperative surveillance to this subset of patients may optimize resource utilization.
Ning
Li
L
Endocrine Surgery Research Laboratories, Department of Surgery, University of Wisconsin, and the University of Wisconsin Paul P. Carbone Comprehensive Cancer Center, Madison, Wisconsin, USA.
Sippel
Rebecca
R
Schaefer
Sarah
S
Chen
Herbert
H
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000097:blood* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy; D011184:Postoperative Period; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome
D010281:Parathyroid Hormone