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Paper 21 (1130)
PERSISTENTLY ELEVATED PTH LEVELS AFTER PARATHYROID SURGERY
Background: - Persistent PTH elevation in normocalcemic patients (PPTH) has been observed to occur after apparently successful parathyroidectomy. Although this has been related to low vitamin D levels, the cause and significance of this remains unclear. This study was undertaken to determine if there is a difference between patients with PPTH and relatively low serum calcium levels compared with those with higher, but normal calcium levels and whether the latter group might represent mild persistent hyperparathyroidism.
The 26th Annual Meeting of the American
Association of Endocrine Surgeons
April 3rd- 5th,2005 - Paradisus Riviera Cancun.
Tracy Wang MD, Samuel Ostrower MD, Keith Heller MD
Long Island Jewish Medical Center, New York, NY
Methods: - The records of 816 patients undergoing surgery for primary hyperparathyroidism were reviewed. 539 of these underwent MIP. 114 patients were identified with PPTH at the first postoperative evaluation. These patients were divided into those with Ca++ < 9.6 (Group 1) and Ca++ 9.6 (Group 2). 80 patients were followed for at least 6 months post operatively and 33 patients for 1 year.
Results: - Patients in Group 1 had significantly higher postoperative PTH (104 vs. 87, p<0.02) than those in Group 2. There was no significant difference in initial postoperative Vit D-25 levels between the two groups. Vit D-25 levels were lower in patients with PPTH than in those with normal postoperative Ca++ and PTH (17 vs. 22, p< 0.01). Initial postoperative Vit D-25 levels were higher in patients with PPTH that resolved over time compared with those that persisted (p=0.11). PTH levels ultimately fell to normal in 59% of Group 1 patients and 71% of Group 2 (p>0.05). Intraoperative PTH (IOPTH) levels fell further in Group 1 than in Group 2 (75% vs. 66%) but in both groups these drops should have predicted successful outcomes. There was no difference in the decrease of IOPTH between patients with persistent PPTH and Ca++ 9.6 and those whose PPTH resolved or persisted with Ca++ < 9.6. 3 patients in Group 2 developed recurrent hyperparathyroidism vs. none in Group 1.
Conclusions: - These data suggest that there is little difference between the two groups except for a small risk of recurrent hyperparathyroidism in Group 2. Further long-term follow-up of these patients is necessary to determine the significance of this condition.