Section of Endocrine Surgery, Department of Surgery, University of Wisconsin, H4/722 CSC 600 Highland Avenue, Madison, WI 53792, USA.
World J Surg. 2011 Sep;35(9):2006-9. doi: 10.1007/s00268-011-1179-3.
Intraoperative parathyroid hormone (IoPTH) testing is useful in the management of hyperparathyroidism. The successful removal of hypersecreting parathyroids is indicated by a decrease in PTH levels >50% within 15 min. A subset of patients with mild hyperparathyroidism will actually have starting PTH levels in the normal range. We sought to determine if IoPTH testing is necessary in these patients and if the 50% rule delineating surgical cure is reliable.
A retrospective review was performed on all patients who underwent parathyroidectomy for hyperparathyroidism at a single institution from 3/2001 to 8/2008.
Of the 1,001 patients, 142 (14%) had mild hyperparathyroidism and normal baseline PTH levels (<65 pg/ml). Their mean PTH was 59 ± 1 pg/ml. During surgery, 105 (74%) had a >50% decline in PTH levels after resection of hyperfunctioning parathyroid glands, and their operations were terminated. In contrast, 37 (26%) patients did not have a >50% decline in PTH levels leading to further surgical exploration. In these 37 patients, the PTH levels fell by >50% after the removal of the additional glands in 25 patients (17.6%) and dropped after 20 min in 7 patients (4.9%). In 5 patients (3.5%) the IoPTH did not drop. Of the 142 total patients, 91 had single adenomas and 51 patients had multi-gland disease. All patients (100%) were cured (normal serum calcium after 6 months).
Intraoperative PTH testing plays an important role in the operative management in 14% of patients with mild hyperparathyroidism. Importantly, a 50% decline in IoPTH level within 15 min of parathyroidectomy is 96.5% reliable in predicting cure in these patients with PTH starting in the normal range.
术中甲状旁腺激素（IoPTH）检测在甲状旁腺功能亢进症的治疗中很有用。15 分钟内 PTH 水平下降>50%表明过度分泌的甲状旁腺已成功切除。一部分轻度甲状旁腺功能亢进症患者的初始 PTH 水平实际上在正常范围内。我们试图确定在这些患者中是否需要进行 IoPTH 检测，以及界定手术治愈的 50%规则是否可靠。
对 2001 年 3 月至 2008 年 8 月在一家医院接受甲状旁腺切除术治疗甲状旁腺功能亢进症的所有患者进行回顾性分析。
在 1001 例患者中，142 例（14%）为轻度甲状旁腺功能亢进症且基础 PTH 水平正常（<65 pg/ml）。他们的平均 PTH 为 59 ± 1 pg/ml。在手术中，105 例（74%）患者在切除功能亢进的甲状旁腺后 PTH 水平下降>50%，手术结束。相比之下，37 例（26%）患者的 PTH 水平下降未超过 50%，导致进一步的手术探查。在这 37 例患者中，25 例（17.6%）在切除额外的腺体后 PTH 水平下降>50%，7 例（4.9%）在 20 分钟后下降。在 5 例（3.5%）患者中，IoPTH 没有下降。在 142 例患者中，91 例为单发腺瘤，51 例为多腺体疾病。所有患者（100%）均治愈（6 个月后血清钙正常）。
在轻度甲状旁腺功能亢进症患者中，14%的患者术中甲状旁腺激素检测在手术管理中发挥重要作用。重要的是，在甲状旁腺切除术后 15 分钟内，IoPTH 水平下降 50%，在 PTH 起始值正常的患者中预测治愈的准确率为 96.5%。
