Factors that influence the assessment of parathyroid graft function.

Autogenous parathyroid grafts are used in the treatment of primary and secondary parathyroid hyperplasia and for salvaging normal parathyroid glands removed during thyroid surgery. Placement of the autogenous grafts in the forearm may allow assessment of graft function by comparing the patient's background level of immunoreactive parathyroid hormone (iPTH) with the iPTH value in the antecubital vein above the parathyroid graft. Among patients who on clinical grounds seem to have functioning parathyroid tissue, significant iPTH gradients can be demonstrated in only approximately 80%. Several technical and clinical factors can prevent demonstration of an iPTH gradient in patients who in fact do have functioning parathyroid grafts. Hypercalcemia may suppress iPTH secretion. PTH secretion may be intermittent. High background levels of iPTH due to renal failure may transform a significant numerical gradient for iPTH into an insignificant percentage change in iPTH. It may be technically difficult to obtain blood from the particular vein bearing effluent from the parathyroid graft. The regional specificity of the iPTH assay employed may have an important influence on the magnitude of the apparent iPTH gradient. Knowledge of these factors should maximize the chance of documenting parathyroid graft function.