Department of Surgery, St. Paul's Hospital & University of British Columbia, Canada.
Department of Pathology & Laboratory Medicine, St. Paul's Hospital & University of British Columbia, Canada.
Am J Surg. 2020 May;219(5):785-789. doi: 10.1016/j.amjsurg.2020.02.049. Epub 2020 Feb 29.
The study objective was to evaluate the intraoperative 50% decrease in PTH level ± PTH normalization for its accuracy and efficiency in predicting cure during parathyroidectomy (PTx) for the treatment of primary hyperparathyroidism (PHP).
A retrospective review of patients undergoing PTx was conducted. The timepoints at which the 50% PTH decrease was reached were recorded. The accuracy of intraoperative PTH for predicting cure, defined as normocalcemia at 6 months postoperatively, was evaluated.
The study population was made up of 248 PHP patients, with 247 patients achieving normocalcemia at 6 months postoperatively. If a 50% PTH decrease was used to indicate operation conclusion, 1 patient would not be cured. Persistent PTH elevation above normal range at T10 had a PPV of 77%, NPV of 99.5%, sensitivity of 95.2% and specificity of 97.3% for predicting the presence of a contralateral pathological parathyroid gland. For the study cohort, 24.5 h of cumulative operating time would be saved if the 50% PTH decrease triggered operation conclusion.
A decrease in the pre-excision PTH level to 50% of the baseline level, or a decrease in the higher of the baseline or pre-excision PTH levels by 50% at 5 or 10 min post pathological parathyroid gland removal, regardless of whether the PTH level normalizes, reliably predicts cure from PHP and should be used to guide the surgeon during parathyroidectomy.
本研究旨在评估甲状旁腺切除术（PTx）治疗原发性甲状旁腺功能亢进症（PHP）时，术中甲状旁腺激素（PTH）水平下降 50%±PTH 正常化在预测治愈方面的准确性和效率。
对接受 PTx 的患者进行回顾性研究。记录达到 50%PTH 下降的时间点。评估术中 PTH 预测治愈的准确性，治愈定义为术后 6 个月血钙正常。
研究人群由 248 例 PHP 患者组成，247 例患者术后 6 个月血钙正常。如果使用 50%PTH 下降来指示手术结束，将有 1 例患者未治愈。术后 10 分钟时持续升高至正常范围以上的甲状旁腺激素（T10）的阳性预测值为 77%，阴性预测值为 99.5%，灵敏度为 95.2%，特异性为 97.3%，预测对侧存在病理性甲状旁腺。对于研究队列，如果 50%PTH 下降触发手术结束，将节省 24.5 小时的累计手术时间。
术前 PTH 水平下降至基线水平的 50%，或术前或术前 PTH 水平较高者下降 50%，在病理甲状旁腺切除后 5 或 10 分钟，无论 PTH 水平是否正常，均可可靠地预测 PHP 治愈，应在甲状旁腺切除术期间用于指导外科医生。
