Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Section of Endocrine Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Surg Res. 2014 Jul;190(1):119-25. doi: 10.1016/j.jss.2014.02.050. Epub 2014 Mar 2.
Curative parathyroidectomy for primary hyperparathyroidism (PHPT) resolves various nonspecific symptoms related to the disease. Between 8% and 40% of patients with normocalcemia after parathyroidectomy have persistently elevated parathyroid hormone (ePTH) levels at follow-up. We investigated whether ePTH in the early postoperative period was associated with the timing of symptom improvement.
This prospective study included adult patients with PHPT who underwent curative parathyroidectomy from November 2011 to September 2012. Biochemical testing at 2 wk postoperatively identified ePTH (defined as PTH>72 pg/mL) versus normal PTH (nPTH). A questionnaire administered pre- and post-operatively at 6 wk and 6 mo asked patients to rate the frequency of 18 symptoms of PHPT on a five-point Likert scale. Student t-tests were used to compare pre- with postoperative changes in scores for individual symptoms.
Of 194 patients who underwent parathyroidectomy, 129 (66%) participated in the study. Preoperatively, all patients were symptomatic, with a mean of 13±4 symptoms. Two weeks postoperatively, 20 patients (16%) had ePTH. The percentage of patients with postoperative improvement for individual symptoms was compared between groups. At the early time point (6 wk), the ePTH group showed less improvement in 14 of 18 symptoms. This difference reached statistical significance for four symptoms: anxiety, constipation, thirst, and polyuria. By the 6-mo time point, these differences had resolved, and symptom improvement was similar between groups.
ePTH after curative parathyroidectomy may result in a delay in symptom improvement 6 wk postoperatively; however, this difference resolves in 6 mo.
甲状旁腺切除术可治愈原发性甲状旁腺功能亢进症（PHPT），并消除与该病相关的各种非特异性症状。在甲状旁腺切除术后血钙正常的患者中，8%至 40%的患者在随访时仍存在甲状旁腺激素（ePTH）水平持续升高。我们研究了术后早期的 ePTH 是否与症状改善的时间有关。
本前瞻性研究纳入了 2011 年 11 月至 2012 年 9 月期间接受甲状旁腺切除术的 PHPT 成年患者。术后 2 周的生化检测确定了 ePTH（定义为 PTH>72pg/mL）与正常 PTH（nPTH）。术前和术后 6 周和 6 个月通过问卷询问患者 PHPT 的 18 种症状的频率，评分采用 5 分制。采用学生 t 检验比较个体症状评分的术前与术后变化。
在接受甲状旁腺切除术的 194 例患者中，有 129 例（66%）参与了本研究。术前所有患者均有症状，平均 13±4 种症状。术后 2 周，20 例（16%）患者出现 ePTH。比较两组间各症状术后改善的患者百分比。在早期（6 周），ePTH 组的 18 种症状中有 14 种改善较少。这一差异在 4 种症状上具有统计学意义：焦虑、便秘、口渴和多尿。到 6 个月时，这些差异已得到解决，两组间的症状改善相似。
甲状旁腺切除术治愈后 ePTH 可能导致术后 6 周时症状改善延迟；然而，这一差异在 6 个月时得到解决。
