Debruyne F, Delaere P, Ostyn F, Van den Bruel A, Bouillon R
Department of Otorhinolaryngology, Head and Neck Surgery, University of Leuven, Belgium.
J Otolaryngol. 1999 Dec;28(6):305-8.
To describe the course of parathyroid hormone (PTH) and serum calcium after surgery for primary hyperparathyroidism and to evaluate the usefulness of daily measurement of these parameters.
Prospective clinical study.
University hospital K. U. Leuven.
Daily monitoring of PTH and serum calcium (preoperatively, the first to the 5th postoperative day, and around the 10th day) in 30 patients where a parathyroid adenoma was removed and in 1 patient with a negative neck exploration.
In the adenoma cases, PTH and serum calcium showed a sharp drop of PTH to a very low level already on the first postoperative day, whereafter a rapid recovery of the PTH was seen. Serum calcium decreased more slowly: on average, the lowest calcium level was measured on the third day, when a majority of the patients were temporarily hypocalcemic; after 2 weeks, only four patients remained slightly hypocalcemic and no one showed recurrence of the hypercalcemia. In contrast, after unsuccessful surgery (biopsy of four normal glands), the PTH decrease on the first day was far less pronounced and the hypercalcemia disappeared only for a short time.
After removal of a parathyroid adenoma, an abrupt fall of PTH precedes the decrease of serum calcium. The first day's PTH level is a reliable indicator of the success of the intervention, and it should be a major point in the postoperative biochemical follow-up. Repeated measurements of serum calcium are useful, but the daily dosage of PTH might be omitted for economic reasons.
描述原发性甲状旁腺功能亢进症手术后甲状旁腺激素（PTH）和血清钙的变化过程，并评估每日测量这些参数的实用性。
前瞻性临床研究。
鲁汶大学医院。
对30例切除甲状旁腺腺瘤的患者和1例颈部探查阴性的患者，每日监测PTH和血清钙（术前、术后第1天至第5天以及第10天左右）。
在腺瘤病例中，PTH和血清钙显示术后第1天PTH就急剧下降至极低水平，此后PTH迅速恢复。血清钙下降较慢：平均而言，最低钙水平在第3天测得，此时大多数患者出现暂时性低钙血症；2周后，只有4例患者仍有轻度低钙血症，且无人出现高钙血症复发。相比之下，手术未成功（对4个正常甲状旁腺进行活检）后，第1天PTH的下降远不明显，高钙血症仅短暂消失。
切除甲状旁腺腺瘤后，PTH的突然下降先于血清钙的下降。术后第1天的PTH水平是干预成功与否的可靠指标，应作为术后生化随访的重点。重复测量血清钙是有用的，但出于经济原因，每日测量PTH可能可以省略。
