Division of Breast and Endocrine Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
Division of Breast and Endocrine Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama.
J Surg Res. 2022 Aug;276:362-368. doi: 10.1016/j.jss.2022.02.011. Epub 2022 Apr 13.
Parathyroidectomy is the standard management for patients with tertiary hyperparathyroidism (THPT) and hypercalcemia. However, a subset of patients with THPT have normal or mildly-elevated serum calcium levels in the setting of significantly elevated parathyroid hormone (PTH). The purpose of this study is to determine the effectiveness and safety of parathyroidectomy in normocalcemic THPT.
Retrospective review of 212 consecutive patients with THPT who subsequently underwent parathyroidectomy between 2001 and 2020 was performed. Patients were categorized as normocalcemic, "mild" (Ca ≤ 10.4 mg/dL) or hypercalcemic, "classic" THPT (Ca ≥ 10.5 mg/dL) and clinical data are compared.
71 of 212 (34%) were normocalcemic with median pre-operative Ca and PTH levels of 9.7 mg/dL and 225pg/mL, respectively and 141 of 212 (67%) were hypercalcemic with median preoperative Ca and PTH levels of 11 mg/dL and 211pg/mL, respectively. The mean length of stay was shorter in normocalcemic patients (0.33 versus 0.50 d; P = 0.03). 10 of 71 (14%) normocalcemic patients underwent reoperative parathyroidectomy, more than double that of hypercalcemic patients (5.6%; P = 0.06). Concomitant thymectomy was performed in 28.1% and 22.1% of normocalcemia and hypercalcemic patients, respectively (P = 0.44). No patient in either group required intravenous calcium or had undetectable PTH levels, but permanent hypocalcemia was more frequent in normocalcemic compared to hypercalcemic patients (11.2% versus 1.4%; P = 0.03).
Parathyroidectomy for normocalcemic tertiary hyperthyroidism (HPT) can be performed safely. These data can help guide multidisciplinary discussions for earlier surgical referral and intervention. Future investigations are needed to evaluate the impact of parathyroidectomy on the renal allograft, bone health, and cardiovascular disease.
甲状旁腺切除术是治疗三发性甲状旁腺功能亢进症（THPT）和高钙血症的标准治疗方法。然而，在甲状旁腺激素（PTH）明显升高的情况下，有一部分 THPT 患者的血清钙水平正常或轻度升高。本研究旨在确定甲状旁腺切除术在血钙正常的三发性甲状旁腺功能亢进症中的有效性和安全性。
回顾性分析了 2001 年至 2020 年间 212 例连续接受甲状旁腺切除术的 THPT 患者。将患者分为血钙正常组（n=71）、“轻度”（Ca≤10.4mg/dL）或“经典”高钙血症组（Ca≥10.5mg/dL，n=141），比较两组患者的临床资料。
71 例患者（34%）血钙正常，术前 Ca 和 PTH 中位数分别为 9.7mg/dL 和 225pg/mL，141 例患者（67%）血钙升高，术前 Ca 和 PTH 中位数分别为 11mg/dL 和 211pg/mL。血钙正常患者的平均住院时间更短（0.33 天 vs. 0.50 天；P=0.03）。71 例血钙正常患者中，有 10 例（14%）需要再次接受甲状旁腺切除术，高于血钙升高患者（5.6%；P=0.06）。血钙正常和升高患者中分别有 28.1%和 22.1%同时行胸腺切除术（P=0.44）。两组均无患者需要静脉补钙或 PTH 水平无法检测，但血钙正常患者的永久性低钙血症更常见（11.2% vs. 1.4%；P=0.03）。
甲状旁腺切除术治疗血钙正常的三发性甲状旁腺功能亢进症是安全的。这些数据有助于指导多学科讨论，以便更早地进行手术转诊和干预。需要进一步研究评估甲状旁腺切除术对肾移植、骨骼健康和心血管疾病的影响。
