Beyer Todd D, Solorzano Carmen C, Prinz Richard A, Babu Ambika, Nilubol Naris, Patel Subhash
Department of Surgery, Rush University Medical Center, Chicago, Ill. 60612, USA.
Surgery. 2007 Jun;141(6):777-83. doi: 10.1016/j.surg.2007.01.025. Epub 2007 Apr 26.
As many as 43% of patients will have normocalcemic intact parathyroid hormone (PTH) elevation after undergoing curative parathyroidectomy for primary hyperparathyroidism. This phenomenon may be due in part to an absolute or relative deficiency of vitamin D, which is under-recognized in patients with primary hyperparathyroidism.
From September 1, 2004, to September 30, 2005, 86 consecutive patients underwent parathyroidectomy for primary sporadic hyperparathyroidism (psHPT). The patients were segregated into 2 groups based on postoperative management. Group 1 was composed of 26 patients who received routine oral calcitriol and calcium carbonate postoperatively. The 60 patients in the second group (group 2) received calcium carbonate postoperatively at the discretion of the primary surgeon.
A total of 85 patients (99%) achieved postoperative cure with sustained reduction in serum calcium. Within 30 days postoperatively, mean serum PTH levels normalized in both groups (41 +/- 31 vs 39 +/- 31 pg/ml; P = .91). However, at 1 to 3 months postoperatively, mean serum calcium levels remained similar (9.5 +/- 0.7 vs 9.3 +/- 0.5 mg/dl; P = .39) whereas mean serum PTH levels in groups 1 and 2 were 43 +/- 25 pg/ml and 67 +/- 45 pg/ml (P = .02), respectively. At 4 to 6 months postoperatively, mean PTH was again higher in group 2 (36 +/- 22 vs 67 +/- 35; P = .03), whereas mean serum calcium levels were normal (9.2 +/- 0.8 vs 9.6 +/- 0.4 mg/dl; P = .18). The incidence of postoperative normocalcemic PTH elevation was significantly higher in group 2 at 1 to 3 months (14% vs 39%; P = .04) and at 7 to 12 months (22% vs 83%; P = .04).
Vitamin D supplementation following parathyroidectomy for primary hyperparathyroidism reduces the incidence of postoperative eucalcemic PTH elevation.
在接受原发性甲状旁腺功能亢进症根治性甲状旁腺切除术后，多达43%的患者会出现血钙正常的甲状旁腺激素（PTH）升高。这种现象可能部分归因于维生素D的绝对或相对缺乏，而这在原发性甲状旁腺功能亢进症患者中未得到充分认识。
从2004年9月1日至2005年9月30日，86例连续患者接受了原发性散发性甲状旁腺功能亢进症（psHPT）的甲状旁腺切除术。根据术后管理将患者分为2组。第1组由26例术后接受常规口服骨化三醇和碳酸钙的患者组成。第二组（第2组）的60例患者由主刀医生酌情决定术后给予碳酸钙。
总共85例患者（99%）术后治愈，血清钙持续降低。术后30天内，两组的平均血清PTH水平均恢复正常（41±31对39±31 pg/ml；P = 0.91）。然而，术后1至3个月，平均血清钙水平保持相似（9.5±0.7对9.3±0.5 mg/dl；P = 0.39），而第1组和第2组的平均血清PTH水平分别为43±25 pg/ml和67±45 pg/ml（P = 0.02）。术后4至6个月，第2组的平均PTH再次升高（36±22对67±35；P = 0.03），而平均血清钙水平正常（9.2±0.8对9.6±0.4 mg/dl；P = 0.18）。术后1至3个月（14%对39%；P = 0.04）和7至12个月（22%对83%；P = 0.04），第2组术后血钙正常的PTH升高发生率显著更高。
原发性甲状旁腺功能亢进症甲状旁腺切除术后补充维生素D可降低术后血钙正常的PTH升高的发生率。
