Masood Maheer M, Hackman Trevor G
Department of Otolaryngology/Head and Neck Surgery, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, United States.
Int Arch Otorhinolaryngol. 2018 Oct;22(4):382-386. doi: 10.1055/s-0038-1635574. Epub 2018 Mar 29.
Intraoperative parathyroid hormone (ioPTH) testing is a widely accepted standard for assessing the parathyroid gland function. A decline of preoperative parathyroid hormone (PTH) levels by more than 50% is one accepted measure of parathyroid surgery adequacy. However, there may be a variation between preoperative PTH levels obtained at a clinic visit and pre-excisional ioPTH. Our study explores the differences between preoperative PTH and pre-excisional ioPTH levels, and the potential impact this difference has on determining the adequacy of parathyroid surgery. A retrospective study that consisted of 33 patients that had undergone parathyroid resection between September 2009 and March 2016 at a tertiary academic center was performed. Each subject's preoperative PTH levels were obtained from clinic visits and pre-excisional ioPTH levels were recorded along with the time interval between the measurements. There was a significant difference between the mean preoperative PTH and the pre-excisional ioPTH levels of 147 pg/mL (95% confidence interval [CI] 11.43 to 284.47; = 0.0396). The exclusion of four outliers revealed a further significant difference with a mean of 35.09 pg/mL (95% CI 20.27 to 49.92; < 0.0001). The average time interval between blood draws was 48 days + 32 days. A weak correlation between the change in PTH values and the time interval between preoperative and pre-excision blood draws was noted (r2 = 0.15). Our study reveals a significant difference between the preoperative PTH levels obtained at clinic visits and the pre-excisional intraoperative PTH levels. We recommend routine pre-excisional intraoperative PTH levels, despite evidence of elevated preoperative PTH levels, in order to more accurately assess the adequacy of surgical resection.
术中甲状旁腺激素（ioPTH）检测是评估甲状旁腺功能的一项广泛认可的标准。术前甲状旁腺激素（PTH）水平下降超过50%是衡量甲状旁腺手术是否充分的一项公认指标。然而，门诊就诊时测得的术前PTH水平与切除前ioPTH水平之间可能存在差异。 我们的研究探讨了术前PTH与切除前ioPTH水平之间的差异，以及这种差异对确定甲状旁腺手术是否充分的潜在影响。 进行了一项回顾性研究，该研究纳入了2009年9月至2016年3月期间在一家三级学术中心接受甲状旁腺切除术的33例患者。从门诊就诊记录中获取每个受试者的术前PTH水平，并记录切除前ioPTH水平以及两次测量之间的时间间隔。 术前PTH平均水平与切除前ioPTH水平之间存在显著差异，为147 pg/mL（95%置信区间[CI] 11.43至284.47；P = 0.0396）。排除四个异常值后，差异进一步显著，平均值为35.09 pg/mL（95% CI 20.27至49.92；P < 0.0001）。采血之间的平均时间间隔为48天±32天。注意到PTH值变化与术前和切除前采血之间的时间间隔之间存在弱相关性（r2 = 0.
