Lee Ji-Eun, Hong Namki, Kim Jin Kyong, Lee Cho Rok, Kang Sang-Wook, Jeong Jong Ju, Nam Kee-Hyun, Chung Woong Youn, Rhee Yumie
Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
Ann Surg Treat Res. 2022 Jul;103(1):12-18. doi: 10.4174/astr.2022.103.1.12. Epub 2022 Jul 7.
The surgical success rate for primary hyperparathyroidism (PHPT) is currently 95%-98%. However, 3%-24% of patients show persistently elevated (Pe) parathyroid hormone (PTH) levels after parathyroidectomy (PTX). This single-center retrospective study aimed to compare the outcomes of patients with normal PTH and PePTH levels after successful PTX and to identify the factors associated with PePTH.
The normal group, defined as patients with normal serum calcium and PTH levels immediately after PTX, was compared with the PePTH group (patients with normal or low serum calcium and increased serum PTH levels up to 6 months postoperatively) to determine the causes of disease in the PePTH group.
There were no significant differences in age, sex, or preoperative estimated glomerular filtration rate between the normal PTH group (333 of 364, 91.5%) and the PePTH group (31 of 364, 8.5%). However, there were significant differences in preoperative 25-hydroxyvitamin D (17.9 and 11.8 ng/mL, respectively; P = 0.003) and PTH levels (125.5 and 212.4 pg/mL, respectively; P < 0.001) between the 2 groups. Among the 31 cases of the PePTH group, 18 were attributed to vitamin D deficiency.
Preoperative vitamin D deficiency is a predictive factor for PePTH. Therefore, preoperative administration of vitamin D supplements may reduce the probability of postoperative disease persistence. Patients with temporary laboratory abnormalities within 6 months after successful PTX should be monitored, and appropriate vitamin D and calcium supplementation may reduce the effort and cost of various examinations or reoperations.
原发性甲状旁腺功能亢进症（PHPT）的手术成功率目前为95%-98%。然而，3%-24%的患者在甲状旁腺切除术后（PTX）甲状旁腺激素（PTH）水平持续升高（Pe）。本单中心回顾性研究旨在比较成功进行PTX后PTH水平正常和PePTH水平患者的结局，并确定与PePTH相关的因素。
将PTX后血清钙和PTH水平立即正常的患者定义为正常组，与PePTH组（术后6个月内血清钙正常或降低且血清PTH水平升高的患者）进行比较，以确定PePTH组的病因。
正常PTH组（364例中的333例，91.5%）和PePTH组（364例中的31例，8.5%）在年龄、性别或术前估计肾小球滤过率方面无显著差异。然而，两组之间术前25-羟维生素D（分别为17.9和11.8 ng/mL；P = 0.003）和PTH水平（分别为125.5和212.4 pg/mL；P < 0.001）存在显著差异。在PePTH组的31例病例中，18例归因于维生素D缺乏。
术前维生素D缺乏是PePTH的预测因素。因此，术前补充维生素D可能会降低术后疾病持续存在的可能性。成功进行PTX后6个月内有临时实验室异常的患者应进行监测，适当补充维生素D和钙可能会减少各种检查或再次手术的工作量和成本。
