title: The deceptive concept of hypoparathyroidism and recurrence after parathyroidectomy in dialysis patients: are we offering a Procrustean bed to some patients?
abstract: to analyze the frequency of hypoparathyroidism and of its recurrence after parathyroidectomy in dialysis patients according to different existing classifications.
  we conducted a retrospective study of 107 consecutive dialysis patients undergoing total parathyroidectomy with immediate autograft in a tertiary hospital from 2006 to 2010. We studied the changes in PTH levels in the postoperative period over time. Were grouped patients according to different PTH levels targets recommended according to the dosage method and by the American and Japanese Nephrology Societies, and by an International Experts Consortium.
  after parathyroidectomy, there was sustained reduction in serum calcium and phosphatemia. The median value of PTH decreased from 1904pg/ml to 55pg/ml in 12 months. Depending on the considered target level, the proportion of patients below the target ranged between 17% and 87%. On the other hand, the proportion of patients with levels above the target ranged from 3% to 37%.
  the application of different recommendations for PTH levels after parathyroidectomy in dialysis patients may lead to incorrect classifications of hypoparathyroidism or recurrent hyperparathyroidism and resultin discordant therapeutic conducts.
  analisar as frequências de hipoparatireoidismo e de recidiva do hiperparatireoidismo após paratireoidectomia em pacientes dialíticos de acordo com diferentes classificações existentes.
  estudo retrospectivo de 107 pacientes dialíticos consecutivamente submetidos à paratireoidectomia total com autoenxerto imediato em um hospital terciário no período de 2006 a 2010. A variação dos níveis de PTH no pós-operatório foi estudada ao longo do tempo. Os pacientes foram agrupados de acordo com diferentes metas de níveis de PTH recomendados de acordo com o método de dosagem e pelas sociedades de nefrologia americana, japonesa e de um consórcio internacional de especialistas.
  após a paratireoidectomia, houve redução sustentada da calcemia e fosfatemia. O valor mediano do PTH reduziu-se de 1904pg/ml para 55pg/ml, em 12 meses. Dependendo do nível alvo considerado, a proporção de pacientes abaixo da meta variou entre 17% e 87%. Ao contrário, a proporção de pacientes com níveis acima da meta variou de 3% a 37%.
  O emprego de diferentes recomendações de níveis de PTH em pacientes dialíticos após paratireoidectomia pode levar a classificações incorretas de hipoparatireoidismo ou hiperparatireoidismo recidivado e implicar em condutas terapêuticas discordantes.
authors.affiliation: Department of Surgery, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Fabio Luiz DE Menezes
authors.initials: FL
authors.lastname: Montenegro
authors.affiliation: Department of Surgery, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Marilia D'Elboux Guimaraes
authors.initials: MD
authors.lastname: Brescia
authors.affiliation: Department of Surgery, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Climério Pereira
authors.initials: CP
authors.lastname: Nascimento
authors.affiliation: Department of Surgery, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Ledo Mazzei
authors.initials: LM
authors.lastname: Massoni
authors.affiliation: Department of Surgery, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Sérgio Samir
authors.initials: SS
authors.lastname: Arap
authors.affiliation: Department of Surgery, Faculty of Medicine, University of São Paulo, Sao Paulo, SP, Brazil.
authors.forename: Stênio Roberto Castro Lima
authors.initials: SR
authors.lastname: Santos
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, São Paulo, SP, Brazil.
authors.forename: Patrícia Taschner
authors.initials: PT
authors.lastname: Goldenstein
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, São Paulo, SP, Brazil.
authors.forename: Rodrigo Oliveira
authors.initials: RO
authors.lastname: Bueno
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, São Paulo, SP, Brazil.
authors.forename: Melani Ribeiro
authors.initials: MR
authors.lastname: Custodio
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, São Paulo, SP, Brazil.
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
authors.affiliation: Department of Internal Medicine, Faculty of Medicine, University of Sao Paulo, São Paulo, SP, Brazil.
authors.forename: Rosa Maria Affonso
authors.initials: RM
authors.lastname: Moyses
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D005260:Female; D006801:Humans; D007011:Hypoparathyroidism / Q000097:blood / Q000601:surgery*; D008297:Male; D010281:Parathyroid Hormone / Q000097:blood; D016105:Parathyroidectomy; D012008:Recurrence; D006435:Renal Dialysis; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D010281:Parathyroid Hormone