title: Factors that influence parathyroid hormone half-life: determining if new intraoperative criteria are needed.
abstract: OBJECTIVE
  Minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring remains the standard approach to the majority of patients with primary hyperparathyroidism. This study demonstrates that individual patient characteristics do not affect existing criteria for intraoperative parathyroid hormone monitoring.
  
  
  OBJECTIVE
  To identify patient characteristics, such as age, sex, race, body mass index (BMI), and renal function, that may affect existing criteria for intraoperative parathyroid hormone (IOPTH) levels during minimally invasive parathyroidectomy.
  
  
  METHODS
  Retrospective review of a prospectively collected parathyroid database populated from August 2005 to April 2011.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  Three hundred six patients with sporadic primary hyperparathyroidism who underwent initial parathyroidectomy between August 2005 and April 2011.
  
  
  METHODS
  All patients underwent minimally invasive parathyroidectomy with complete IOPTH information.
  
  
  METHODS
  Individual IOPTH kinetic profiles were fitted with an exponential decay curve and individual IOPTH half-lives were determined. Univariate and multivariate analyses were performed to determine the association between patient demographics or laboratory data and IOPTH half-life.
  
  
  RESULTS
  Mean age of the cohort was 60 years, 78.4% were female, 90.2% were white, and median BMI was 28.3. Overall, median IOPTH half-life was 3 minutes, 9 seconds. On univariate analysis, there was no association between IOPTH half-life and patient age, renal function, or preoperative serum calcium or parathyroid hormone levels. Age, BMI, and an age × BMI interaction were included in the final multivariate median regression analysis; race, sex, and glomerular filtration rate were not predictors of IOPTH half-life. The IOPTH half-life increased with increasing BMI, an effect that diminished with increasing age and was negligible after age 55 years (P = .001).
  
  
  CONCLUSIONS
  Body mass index, especially in younger patients, may have a role in the IOPTH half-life of patients undergoing parathyroidectomy. However, the differences in half-life are relatively small and the clinical implications are likely not significant. Current IOPTH criteria can continue to be applied to all patients undergoing parathyroidectomy for sporadic primary hyperparathyroidism.
authors.affiliation: Department of Surgery, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Leiker
authors.forename: Tina W F
authors.initials: TW
authors.lastname: Yen
authors.forename: Dan C
authors.initials: DC
authors.lastname: Eastwood
authors.forename: Kara M
authors.initials: KM
authors.lastname: Doffek
authors.forename: Aniko
authors.initials: A
authors.lastname: Szabo
authors.forename: Douglas B
authors.initials: DB
authors.lastname: Evans
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Wang
mesh_terms: D000368:Aged; D005260:Female; D006207:Half-Life; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D016343:Monitoring, Intraoperative; D010281:Parathyroid Hormone / Q000097:blood*; D016105:Parathyroidectomy / Q000379:methods; D012189:Retrospective Studies
chemical_list: D010281:Parathyroid Hormone