Wolf Henning Wendelin, Canovi Sara, Nebiker Christian Andreas
Department of General Surgery, Cantonal Hospital of Aarau, Aarau, Switzerland.
Sankt Vinzenz Hospital Rheda-Wiedenbrueck, Rheda-Wiedenbrueck, Germany.
Langenbecks Arch Surg. 2025 Jul 10;410(1):220. doi: 10.1007/s00423-025-03796-4.
Intraoperative parathyroid hormone (PTH) measurement is a beneficial tool in the surgical management of primary hyperparathyroidism. The expected degree of intraoperative PTH reduction, which guides surgical decision-making, determines the sensitivity and specificity of this test. While stricter criteria may enhance diagnostic accuracy, an optimal threshold has not been conclusively established. The aim of this study was to identify the PTH reduction threshold that provides the highest sensitivity and specificity for achieving biochemical cure.
A retrospective analysis was conducted on 141 patients who underwent parathyroidectomy for primary hyperparathyroidism, focusing on the intraoperative drop in PTH and surgical success. A receiver operating characteristic analysis was performed to identify the optimal threshold that balances sensitivity and specificity in predicting biochemical cure.
The mean percentage reduction at the end of surgery was 73.93% (SD ± 16.54%) with an overall cure rate of 94%. The area under the curve was 0.73 for a 50% PTH reduction, 0.77 for a 60% reduction, and 0.68 for a 70% reduction.
The optimal balance between sensitivity and specificity was achieved with a 60% intraoperative PTH reduction. Stricter criteria increase sensitivity but may also raise the risk of surgical overtreatment.
术中甲状旁腺激素（PTH）测定是原发性甲状旁腺功能亢进症外科治疗中的一项有益工具。术中PTH降低的预期程度指导手术决策，决定了该检测的敏感性和特异性。虽然更严格的标准可能会提高诊断准确性，但尚未最终确定最佳阈值。本研究的目的是确定能为实现生化治愈提供最高敏感性和特异性的PTH降低阈值。
对141例行原发性甲状旁腺功能亢进症甲状旁腺切除术的患者进行回顾性分析，重点关注术中PTH的下降情况及手术成功率。进行了受试者操作特征分析，以确定在预测生化治愈时平衡敏感性和特异性的最佳阈值。
手术结束时PTH平均降低百分比为73.93%（标准差±16.54%），总体治愈率为94%。PTH降低50%时曲线下面积为0.73，降低60%时为0.77，降低70%时为0.68。
术中PTH降低60%可实现敏感性和特异性的最佳平衡。更严格的标准会提高敏感性，但也可能增加手术过度治疗的风险。
