Persistently elevated parathyroid hormone levels after parathyroid surgery

Persistent elevation of serum parathyroid hormone (PTH), despite normocalcemia, occurs in 8% to 40% of patients after parathyroidectomy. Explanations have included hypocalcemia owing to vitamin D deficiency or bone remineralization, and persistent hyperparathyroidism. A retrospective chart review of...

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Bibliographic Details
Published in:Surgery 2005-12, Vol.138 (6), p.1130-1136
Main Authors: Wang, Tracy S., Ostrower, Samuel T., Heller, Keith S.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Calcifediol - blood
Calcium - blood
Female
Follow-Up Studies
Humans
Hyperparathyroidism - blood
Hyperparathyroidism - surgery
Male
Middle Aged
Parathyroid Hormone - blood
Parathyroidectomy
Recurrence
Retrospective Studies
Treatment Outcome
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Summary:Persistent elevation of serum parathyroid hormone (PTH), despite normocalcemia, occurs in 8% to 40% of patients after parathyroidectomy. Explanations have included hypocalcemia owing to vitamin D deficiency or bone remineralization, and persistent hyperparathyroidism. A retrospective chart review of 816 consecutive patients who underwent surgery for primary hyperparathyroidism was conducted. One hundred fourteen patients (15%) had persistently elevated PTH levels (PPTH). Patients with PPTH had higher preoperative PTH levels than those with normal PTH levels postoperatively. They also had lower postoperative Ca ++ and vitamin D levels. Multiple gland enlargement was identified in fewer patients with PPTH than in those with normal postoperative PTH levels. In patients with PPTH and a postoperative Ca ++ less than 9.6 mg/dL (group I), there was a greater decrease in IOPTH, a higher initial postoperative PTH level, and a lower postoperative vitamin D level than in PPTH patients whose postoperative Ca ++ was ≥9.6 mg/dL (group II). Postoperative Ca ++ and vitamin D levels were also lower in patients whose PPTH did not ultimately resolve. Three patients in group II had recurrent disease. Persistent elevation of postoperative serum PTH levels in normocalcemic patients is associated with mild hypocalcemia, probably owing to vitamin D deficiency. In some patients it may also be indicative of mild persistent hyperparathyroidism.
ISSN:0039-6060
1532-7361
DOI:10.1016/j.surg.2005.08.026