Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism

Carmen C. Solorzano, William Mendez, John Lew, Steven Rodgers, Raquel Montano, Denise M. Carneiro-Pla, George L. Irvin

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

Hypothesis: Untreated long-term elevated parathyroid hormone (PTH) levels after successful parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear. Design: Retrospective case series. Setting: Tertiary referral center. Patients: Five hundred seventy-six consecutive patients with HPT. Intervention: Parathyroidectomy guided by intraoperative monitoring of PTH levels. Main Outcome Measures: Overall incidence of elevated PTH levels (measurements of ≥70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after parathyroidectomy). Results: Of the 505 patients who underwent successful parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7%) consistently had PTH levels within the reference range, and 168 (33.3%) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8%) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency. Conclusion: Although one-third of the patients had elevated PTH levels after successful parathyroidectomy, most of these patients with elevated PTH levels (95%) will achieve long-term eucalcemia.

Original languageEnglish
Pages (from-to)659-663
Number of pages5
JournalArchives of Surgery
Volume143
Issue number7
DOIs
StatePublished - Jul 1 2008

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Parathyroidectomy
Primary Hyperparathyroidism
Parathyroid Hormone
Hyperparathyroidism
Intraoperative Monitoring
Hypercalcemia
Tertiary Care Centers
Renal Insufficiency
Reference Values

ASJC Scopus subject areas

  • Surgery

Cite this

Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism. / Solorzano, Carmen C.; Mendez, William; Lew, John; Rodgers, Steven; Montano, Raquel; Carneiro-Pla, Denise M.; Irvin, George L.

In: Archives of Surgery, Vol. 143, No. 7, 01.07.2008, p. 659-663.

Research output: Contribution to journalArticle

Solorzano, Carmen C. ; Mendez, William ; Lew, John ; Rodgers, Steven ; Montano, Raquel ; Carneiro-Pla, Denise M. ; Irvin, George L. / Long-term outcome of patients with elevated parathyroid hormone levels after successful parathyroidectomy for sporadic primary hyperparathyroidism. In: Archives of Surgery. 2008 ; Vol. 143, No. 7. pp. 659-663.
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abstract = "Hypothesis: Untreated long-term elevated parathyroid hormone (PTH) levels after successful parathyroidectomy may predict recurrent hyperparathyroidism (HPT). Although elevated PTH levels have been reported in eucalcemic patients after parathyroidectomy for sporadic primary HPT, the long-term clinical significance of this finding remains unclear. Design: Retrospective case series. Setting: Tertiary referral center. Patients: Five hundred seventy-six consecutive patients with HPT. Intervention: Parathyroidectomy guided by intraoperative monitoring of PTH levels. Main Outcome Measures: Overall incidence of elevated PTH levels (measurements of ≥70 pg/mL at any time during follow-up) and recurrent HPT (hypercalcemia and elevated PTH levels more than 6 months after parathyroidectomy). Results: Of the 505 patients who underwent successful parathyroidectomy in this series and were followed up for more than 6 months, 337 (66.7{\%}) consistently had PTH levels within the reference range, and 168 (33.3{\%}) had elevated PTH levels. Of the 168 patients with elevated PTH levels, only 8 (4.8{\%}) developed recurrent disease. The earliest recurrence occurred 2 years postoperatively. Factors associated with elevated PTH levels included advanced age, higher preoperative PTH levels, and mild postoperative renal insufficiency. Conclusion: Although one-third of the patients had elevated PTH levels after successful parathyroidectomy, most of these patients with elevated PTH levels (95{\%}) will achieve long-term eucalcemia.",
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