Quick PTH assay cannot predict incomplete parathyroidectomy in patients with renal hyperparathyroidism

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BackgroundContradictory reports on the value of intraoperative quick parathyroid hormone (PTH) monitoring in renal hyperparathyroidism have been published.MethodsThirty-five consecutive patients underwent total parathyroidectomy, central neck dissection, bilateral thymectomy, and immediate autotransplantation. PTH levels were measured by PTH assay at induction of anesthesia (baseline level) and in 5-minute intervals after excision of the last parathyroid gland. Parathyroidectomy was considered “total” in patients with PTH levels <10 pg/mL (subgroup 1), “subtotal” between 10 and 65 pg/mL (subgroup 2) and “insufficient” at >65 pg/mL (subgroup 3) within the first postoperative week.ResultsFifteen minutes after excision of the last gland, PTH levels dropped to 19.4 ± 15.7% (subgroup 1), 14.9 ± 5.9% (subgroup 2), and 18 ± 6.7% (subgroup 3) from baseline among 22 patients on hemodialysis, to 22.1 ± 18.7% and 17.5% in 9 patients (subgroups 1 and 2) after successful kidney transplantation, and to 10.7% and 17.5% (subgroup 1) and 12.8% and 31.4% (subgroup 2) in 4 patients with reduced renal function after kidney transplantation.ConclusionsCurrently available QPTH assays are not useful to predict insufficient resection of hyperfunctioning parathyroid tissue.

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