Primary hyperparathyroidism with normal baseline intraoperative parathyroid hormone: A challenging population

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• 作者：Mahsa Javid ; MD ; DPhil ; Glenda Callender ; MD ; Courtney Quinn ; MD ; MS ; Tobias Carling ; MD ; PhD ; Patricia Donovan ; RN ; MBA ; Robert Udelsman ; MD ; MBA ; ^{robert.udelsman@yale.edu}
• 刊名：Surgery
• 出版年：2017
• 出版时间：February 2017
• 年：2017
• 卷：161
• 期：2
• 页码：493-498
• 全文大小：120 K
• 卷排序：161

文摘

Patients with primary hyperparathyroidism and baseline intraoperative parathyroid hormone levels in the normal range are challenging. This study compares the predictive value of a commonly used intraoperative parathyroid hormone algorithm, a software model for cure prediction, and surgeon judgment in this population.MethodsThis was a retrospective review of consecutive patients who underwent parathyroidectomy for primary hyperparathyroidism at a single institution from March 2013 to October 2014.ResultsOf 541 operative patients, 114 (21.1%) had a mean normal baseline intraoperative parathyroid hormone of ≤69 pg/mL (median 59.0 ± 10.3; range 26–69). Of the 114 patients, 93 (81.6%) were women, median age was 61 years (range 18–88). Overall, 107/108 (99.1%) patients were cured; 47 (41.2%) patients had single adenomas, 16 (14%) had double adenomas, and 51 (44.7%) had multigland hyperplasia. Using the 50% decline algorithm, a correct prediction was made in 86 (75.4%) patients. Using the computer software, a correct prediction was made in 88 (77.2%) patients. Surgeon judgment, however, was 99.1% accurate.ConclusionPatients with normal baseline intraoperative parathyroid hormone have a high incidence of multigland disease (58.8%), greater than reported previously. Current software modeling and the 50% decline algorithm are insufficient to predict cure in this population; intraoperative parathyroid hormone interpretation combined with operative findings and surgical judgment yield optimal outcomes.