Persistently Elevated PTH After Parathyroidectomy at One Year: Experience in a Tertiary Referral Center

Overview

Journal J Clin Endocrinol Metab

Publisher Oxford University Press

Specialty Endocrinology

Date 2019 Jun 13

PMID 31188435

Citations 13

Authors

Marie Caldwell

Jeff Laux

Marshall Clark

Lawrence Kim

Janet Rubin

Affiliations

Soon will be listed here.

Abstract

Context/objective: Increased PTH after successful parathyroid surgery represents a clinical conundrum. We aimed to determine the prevalence of persistently elevated PTH (PePTH) postsurgery, along with predisposing factors.

Design: and Setting: Patients ≥ age 18 with parathyroidectomy performed at University of North Carolina Hospitals for primary hyperparathyroidism (PHPT) over a 12-year period were identified from the Carolina Data Warehouse. Clinical and demographic characteristics were collected, transformed, and analyzed.

Results: Five hundred seventy patients met initial criteria for PHPT, and of those 407 had postoperative values. One hundred forty-four had laboratory results within 3 to 18 months post operatively. There was no clinical difference between those with and without long-term laboratory follow-up. Presurgery, patients had average calcium of 11 mg/dL and PTH 125.4 pg/mL. Ninety-seven percent of patients had normalized calcium after surgery, but 30% had PePTH, which can be predicted at 3 months. Patients with PePTH (persistent elevation of PTH) after surgery did not differ from those with normalized PTH in terms of sex, age, body mass index, or excised gland weight; presurgery 25-vitamin D was slightly lower, but not abnormal (26 ± 15 vs 36 ± 11). The presurgical PTH was significantly higher (P < 0.001) in those with PePTH (156.5 pg/mL compared with presurgical level of 102.5 in those whose PTH normalized).

Conclusions: Nearly one-third of PHPT patients have elevated PTH levels postsurgery in a tertiary hospital setting. At presentation, patients with PePTH tend to have higher PTH relative to calcium levels. Whether PePTH after surgical treatment of PHPT has pathological consequences is unknown.

Citing Articles

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Case report: a rare case of primary hyperparathyroidism due to an intrathymic ectopic parathyroid adenoma incidentally diagnosed in a 15-year-old girl.

Gurluler E Front Endocrinol (Lausanne). 2024; 15:1371098.

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Efficacy and safety of radiofrequency ablation for primary and secondary hyperparathyroidism: a retrospective study.

Qiu X, Gao M, Zhang D, Ji F Sci Rep. 2023; 13(1):16949.

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A rare case of "Brown tumor" of the axis with parathyroid adenoma and tertiary hyperparathyroidism.

Srikantha U, Hari A, Lokanath Y, Mahesh D J Craniovertebr Junction Spine. 2023; 14(1):97-102.

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The Eucalcemic Patient With Elevated Parathyroid Hormone Levels.

Shaker J, Wermers R J Endocr Soc. 2023; 7(4):bvad013.

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