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. 2016 May 27:6:26841.
doi: 10.1038/srep26841.

Diagnostic Accuracy Study of Intraoperative and Perioperative Serum Intact PTH Level for Successful Parathyroidectomy in 501 Secondary Hyperparathyroidism Patients

Lina Zhang  1 , Changying Xing  1 , Chong Shen  2 , Ming Zeng  1 , Guang Yang  1 , Huijuan Mao  1 , Bo Zhang  1 , Xiangbao Yu  1 , Yiyao Cui  3 , Bin Sun  1 , Chun Ouyang  1 , Yifei Ge  1 , Yao Jiang  1 , Caixia Yin  1 , Xiaoming Zha  3 , Ningning Wang  1
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Free PMC article

Diagnostic Accuracy Study of Intraoperative and Perioperative Serum Intact PTH Level for Successful Parathyroidectomy in 501 Secondary Hyperparathyroidism Patients

Lina Zhang et al. Sci Rep. .
Free PMC article

Abstract

Parathyroidectomy (PTX) is an effective treatment for severe secondary hyperparathyroidism (SHPT); however, persistent SHPT may occur because of supernumerary and ectopic parathyroids. Here a diagnostic accuracy study of intraoperative and perioperative serum intact parathyroid hormone (iPTH) was performed to predict successful surgery in 501 patients, who received total PTX + autotransplantation without thymectomy. Serum iPTH values before incision (io-iPTH0), 10 and 20 min after removing the last parathyroid (io-iPTH10, io-iPTH20), and the first and fourth day after PTX (D1-iPTH, D4-iPTH) were recoded. Patients whose serum iPTH was >50 pg/mL at the first postoperative week were followed up within six months. Successful PTX was defined if iPTH was <300 pg/mL, on the contrary, persistent SHPT was regarded. There were 86.4% patients underwent successful PTX, 9.8% remained as persistent SHPT and 3.8% were undetermined. Intraoperative serum iPTH demonstrated no significant differences in two subgroups with or without chronic hepatitis. Receiver operating characteristic (ROC) curves showed that >88.9% of io-iPTH20% could predict successful PTX (area under the curve [AUC] 0.909, sensitivity 78.6%, specificity 88.5%), thereby avoiding unnecessary exploration to reduce operative complications. D4-iPTH >147.4 pg/mL could predict persistent SHPT (AUC 0.998, sensitivity 100%, specificity 99.5%), so that medical intervention or reoperation start timely.

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Figures

Figure 1
Figure 1. Flow chart of our study.
*Patients not necessarily followed-up.
Figure 2
Figure 2. Number of parathyroid glands removed in PTX patients.
Figure 3
Figure 3. Levels of serum iPTH at 10 or 20 minutes after PTX (io-iPTH10, io-iPTH20) and their percentage reduction (io-iPTH10%, io-iPTH20%) in patients with or without hepatitis.
Figure 4
Figure 4. The change of serum iPTH level among different groups after PTX.
Figure 5
Figure 5. The ROC curves for predicting of successful PTX or persistent SHPT.
See this image and copyright information in PMC

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