Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism

Kara, Muammer; Tellioglu, Gurkan; Bugan, Ugur; Krand, Osman; Berber, İbrahim; Seymen, Pınar; Ata, Pinar; Özel, Leyla; Titiz, İzzet

doi:10.1002/lary.21023

Cited by 26 publications

(30 citation statements)

References 43 publications

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“…Based on the anatomic and developmental characteristics of parathyroid glands, surgical procedures for SHPT patients include subtotal parathyroidectomy (sPTX) and total parathyroidectomy (tPTX) with or without autotransplantation (AT). Ectopic parathyroid could exist in any location of the migration path including the intrathyroid, carotid sheath, thymus, and upper mediastinum13. According to previous data, the frequency of ectopic parathyroid glands was about 15% in SHPT patients161718.…”

Section: Discussionmentioning

confidence: 95%

“…According to previous studies, serum iPTH levels detected at the first postoperative week <300 pg/mL was the criterion of successful PTX13. Here we adopted a stricter criterion.…”

Section: Concise Methodsmentioning

confidence: 99%

“…The half-life of iPTH was suggested to be about 2 minutes under normal kidney function10 and about 5 minutes under renal failure8. Although several studies have investigated the predictive value of intraoperative iPTH (io-iPTH) in SHPT patients111213, the results are still controversial. Whether chronic hepatitis affects io-iPTH diagnostic accuracy in PTX patients remains unknown.…”

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confidence: 99%

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

Zhang

Xing

Shen

et al. 2016

Sci Rep

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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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Section: Discussionmentioning

confidence: 95%

“…According to previous studies, serum iPTH levels detected at the first postoperative week <300 pg/mL was the criterion of successful PTX13. Here we adopted a stricter criterion.…”

Section: Concise Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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

Zhang

Xing

Shen

et al. 2016

Sci Rep

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“…(7–9) Elevated calcium phosphate product (> 55 to 70) was another historic indication for parathyroidectomy, while the development of calciphylaxis or severe renal osteodystrophy are still considered indications for surgery. (8, 10–12) Indications for reoperation are equally ambiguous. At present there are no standardized criterions for parathyroidectomy indications, nor are success, persistence, or recurrence after parathyroidectomy for SHPT well defined.…”

Section: Introductionmentioning

confidence: 99%

“…At present there are no standardized criterions for parathyroidectomy indications, nor are success, persistence, or recurrence after parathyroidectomy for SHPT well defined. (8, 9, 11, 13–17)…”

Section: Introductionmentioning

confidence: 99%

Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism

Oltmann

Madkhali

Sippel

et al. 2015

Journal of Surgical Research

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Introduction Patients with end stage renal disease(ESRD) develop hypocalcemia, resulting in secondary hyperparathyroidism(SHPT). No clear criterions exist to aid in surgical decision making for SHPT. The 2009 Kidney Disease: Improving Global Outcomes(KDIGO) guidelines provide target ranges for serum calcium, phosphate and parathyroid hormone(PTH) levels in patients with ESRD. Parathyroidectomy can help achieve these targets. The study purpose is to examine how parathyroidectomy for SHPT impacts KDIGO targets during immediate and long-term follow-up, and to evaluate KDIGO categorization with receipt of additional surgical intervention. Methods A retrospective review of a prospective parathyroidectomy database was performed. Included patients had SHPT, were on dialysis and underwent parathyroidectomy. Calcium, phosphate and PTH values were classified as below, within, or above KDIGO targets. Results Between 2000 and 2013, 36 patients with SHPT met criteria. Subtotal parathyroidectomy was performed in 89%, total parathyroidectomy in 11%. Follow-up time was 54±7 months. 8 patients(22%) required additional surgery. 28 patients(76%) were alive at last follow-up. At last follow up, patients had phosphate(46%), and PTH(17%) above KDIGO ranges. Factors associated with re-operation were assessed. Patient PTH within or above target immediately post-operative had a higher rate of reoperation(p<0.01). At last follow-up, higher phosphate(p=0.054) and PTH(p<0.001) were associated with higher reoperation rates, but calcium(p=0.33) was not. Conclusions PTH and phosphate levels above KDIGO indices were associated with additional surgical intervention. Many patients had laboratory indices above range at last follow-up, suggesting more patients had persistent or recurrent disease than underwent reoperation. Patients may benefit from more aggressive medical and/or surgical management.

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Protocol driven outcomes in renal parathyroid surgery

et al. 2019

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Background Patients who require surgery for renal hyperparathyroidism represent a special population that is at high risk for postoperative complications. To optimize their treatment, we developed a multidisciplinary approach to the perioperative management of these patients undergoing parathyroidectomy. Methods The Augusta University endocrine surgery parathyroid database was interrogated to identify dialysis‐dependent patients undergoing parathyroidectomy from 2005 to 2015. Numerous clinical parameters were quantified. Patients were stratified into protocol patients and nonprotocol patients. Results A total of 42 patients undergoing renal parathyroidectomy who met the inclusion criteria were identified. Serious adverse events were nearly twice as common in the patients not treated on protocol. The length of stay was nearly 2 days shorter in the protocol group. Lowest calcium level and ionized calcium was higher in the protocol cohort despite a lower postoperative parathyroid hormone. The protocol group had fewer laboratory draws. Conclusion Implementation of a multidisciplinary renal hyperparathyroidism protocol has resulted in improved perioperative outcomes.

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Evaluation of intraoperative parathormone measurement for predicting successful surgery in patients undergoing subtotal/total parathyroidectomy due to secondary hyperparathyroidism

Cited by 26 publications

References 43 publications

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

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

Kidney Disease Improving Global Outcomes guidelines and parathyroidectomy for renal hyperparathyroidism

Protocol driven outcomes in renal parathyroid surgery

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