Clinical value of intraoperative parathyroid hormone determination in secondary hyperparathyroidism operation

Abstract

Objective:To investigate the clinical value of intraoperative parathyroid hormone monitoring in operation of patients with secondary hyperparathyroidism（SHPT）. Method:A retrospective analysis was carried out and enrolled， including 100 primary surgery and 14 second surgery. The data of 100 patients with primary surgery and 14 patients with reoperation were retrospectively analyzed. The criterion, predicting the success of surgery, is that the measured iPTH level declines by more than 80% compared with that before surgery, 20 minutes after the last parathyroid gland removed. Serum calcium, serum phosphorus and iPTH tested pre-and post-operation were statistically analyzed. Result:112 cases（98 cases in the first operation and 14 cases in the second operation） were cured by operation and the cure rate is 98.2%. In 109 cases（97 cases of first operation and 12 cases of reoperation）, the intraoperative determination of parathyroid hormone was up to standard, and the sensitivity of predicting the success of surgery was 97.0% and 85.7%, respectively. Postoperative clinical symptoms such as joint pain and skin itching, etc. were significantly improved or disappeared. Postoperative iPTH, serum calcium and serum phosphorus were significantly different from those before surgery, and the difference was statistically significant（P<0.05）. Conclusion:Intraoperative parathyroid hormone monitoring has vital clinical guiding value for SHPT, and can improve the success rate significantly. A more than 80% reduction in iPTH at 20 min after the last parathyroidectomy was a good predictor of successful surgery.