Parathyroid Hormone Levels Research Articles

Parathyroid hormone levels following denosumab vs. zoledronic acid therapy for osteoporosis.

The objective of this retrospective, database study was to characterize the rate, magnitude and timeline of increases in parathyroid hormone (PTH) levels post-denosumab (DMAb) vs. zoledronic acid (ZA) injection in patients with osteoporosis and near normal baseline PTH. Included were osteoporotic females, ≥50 years, initiating treatment with 60 mg DMAb or 5 mg ZA. PTH levels within 6-months post-DMAb or 12-months post-ZA injection were extracted from the electronic database of a 4.5 million-member health maintenance organization. The indication for PTH measurements was unknown. Exclusion criteria were creatinine >2 mg/dL, vitamin D < 50 nmol/L or parathyroid hormone level > 1.5 × upper limit of normal (ULN). Among 3317 women, 1992 received DMAb and 1325 ZA. The DMAb group was older (73.3 ± 8.5 vs. 69.8 ± 8.6 years, p < 0.001) and more patients treated with DMAb compared with patients treated with ZA had prior non-vertebral fractures (7.7 % vs. 5.2 %, p < 0.01) and had previously been treated with osteoporosis medication (56.3 % vs. 50.3 %, p < 0.001). Among the patients, 14.9 % had at least one post-treatment PTH > 1.5 ULN. Of 7273 post-treatment PTH tests, 62.6 % were within normal limits, while 24.8 % were mildly elevated at 1.01-1.5 ULN. Two-months after both treatments, >1.5 ULN PTH levels peaked at ~20 %. Elevated PTH was associated with eGFR < 60 mL/min/1.73 m2 and comorbidities. In conclusion, most PTH levels post-DMAb or ZA in osteoporotic patients with baseline PTH < 1.5 ULN, were within normal range. PTH increased to >1.5 ULN in 14.9 % of patients; peaking in the first 2-months post-treatment and declining thereafter. Elevated PTH may be related to anti-resorptive effects and is not medication specific. PTH measurements in the first few months post-DMAb and ZA therapy should be limited.

Presentation and Surgical Outcomes of Primary Hyperparathyroidism After Radioactive Iodine Therapy.

Radioactive iodine (RAI) is a common treatment for various thyroid diseases. Previous studies have suggested susceptibility of parathyroid glands to the mutagenic effect of RAI and the development of primary hyperparathyroidism (PHPT). We tested the possible link between prior RAI treatment, disease presentation, and treatment outcomes. A retrospective analysis of 704 individuals who underwent parathyroidectomy for PHPT at a tertiary care center between the years 2015 and 2023 was performed. Preoperative and postoperative parameters, including demographic characteristics, biochemical markers, imaging data, and surgical and pathology findings were collected and analyzed to compare differences in patients who had previous RAI treatment and those who did not (non-RAI). Univariate statistical analyses were performed. Twenty-nine patients had a history of RAI treatment. Indications for RAI treatment included hyperthyroidism (n=18), papillary thyroid cancer (n=6), subacute thyroiditis (n=1), follicular cancer (n=1), and toxic goiter (n=1). Average latency time between RAI exposure and development of PHPT was 18.4ys. On comparison of the two groups, there was no difference in age, sex, race/ethnicity, day of surgery body mass index, preoperative parathyroid hormone, calcium, glomerular filtration rate, creatinine, vitamin D, or phosphate levels. There was also no difference in preoperative diagnosis of osteoporosis or nephrolithiasis. Postoperatively, there was no difference in parathyroid hormone, calcium, or creatinine levels, or in rate of cure. There was significantly higher chance of unilateral exploration in the operating room (75.9% RAI, 54.1% non-RAI, P=0.02) and increased rate of single-gland disease in the RAI group, although the latter finding was not statistically significant (79.3% RAI, 65.2% non-RAI, P=0.12). There was no difference in adenoma size as noted on the pathology report (greatest dimension 1.7cm RAI, 1.7cm non-RAI, P=0.28). Subgroup analysis of the RAI group based on reason for RAI treatment (cancer versus hyperthyroidism) showed no statistically significant differences in the examined demographic or clinical data. There does not seem to be a relationship between prior RAI treatment and the clinical presentation of PHPT. Additionally, differences in RAI dose do not appear to be associated with a change in clinical presentation. Our study revalidates that age and latency are inversely related, which is a previously shown finding. Clinicians may be reassured that patients with prior RAI history may not have differences in clinical characteristics, disease presentation, or treatment outcomes.

Efficacy of HA130 Hemoadsorption in Removing Advanced Glycation End Products in Maintenance Hemodialysis Patients.

Patients on maintenance hemodialysis (HD) face complications due to the accumulation of protein-bound uremic toxins, such as advanced glycation end products (AGEs), which contribute to inflammation, oxidative stress, and cardiovascular disease. Conventional HD techniques inadequately remove AGEs. This study evaluates the efficacy of the HA130 hemoadsorption cartridge combined with high-flux HD (HF-HD) in enhancing AGE removal. This prospective, single-center study included 20 maintenance HD patients randomized into two groups: HF-HD alone (n = 10) and HF-HD plus hemoadsorption (n = 10). Blood samples were collected before and after a single session to measure carboxymethyllysine (CML), soluble RAGE (sRAGE), prolactin, and parathyroid hormone (PTH) levels. Reduction ratios (RR) were calculated, including corrected for hemoconcentration (RRc), to ensure accuracy. Statistical analyses included Mann-Whitney U and Chi-square tests. The HF-HD plus hemoadsorption group showed significantly enhanced removal of CML compared to HF-HD alone, with RRc of 64.7% [52.6-74.9] versus 39.3% [33.8-49.4], respectively (p = 0.045). Similarly, uncorrected reduction ratios demonstrated a trend favoring hemoadsorption, with values of 57.5% [45.1-70.7] versus 30.3% [19.1-44.5] (p = 0.053). Importantly, sRAGE levels were preserved in both groups (RRc: 23.4% (15.1-30.4) vs. 21.8% (16.6-31.7), p = 0.791), highlighting the safety of hemoadsorption. Other biochemical parameters, including prolactin, PTH, albumin, and electrolytes, showed no significant differences between groups. All sessions were completed without adverse events. Combining hemoadsorption with HF-HD significantly enhances CML removal, as evidenced by corrected RR, without compromising protective sRAGE levels. This innovative approach offers a promising adjunctive therapy for reducing AGEs-related complications in end-stage renal disease patients. Further longitudinal studies are needed to confirm these findings and evaluate long-term outcomes.

An exceptionally rare case of a giant parathyroid adenoma with carcinoma-like presentation.

Giant parathyroid adenoma (GPA) is an extremely rare cause of primary hyperparathyroidism (PHPT) and may sometimes mimic parathyroid carcinoma (PC). Parathyroid carcinoma is also a very rare entity. Both preoperative and postoperative diagnosis of the two conditions remains a challenge. The purpose of this article is to present the diagnostic and therapeutic approach used for a 76-year-old female patient with a GPA measuring 5.4 × 2.3cm, mimicking PC. The patient was referred to our clinic for the management of severe hypercalcemia revealed during the neurological evaluation of psychiatric and cognitive symptoms, confusion, weakness, and bone pain. PHPT was confirmed based on the patient's biochemical profile, which showed extremely high levels of serum calcium and parathyroid hormone (PTH). Wholebody computed tomography revealed a large nodule below the inferior pole of the right lobe of the thyroid gland and no further pathology in other organs. En bloc resection of the tumor with removal of the ipsilateral hemithyroid and other involved tissues was performed. Histopathological evaluation was diagnostic for a GPA. Post-surgery hungry bone syndrome (HBS) developed and was treated. However, the patient succumbed 3 weeks later due to septic shock. GPA is an exceptionally rare endocrine tumor that should be suspected along with PC in patients with significantly elevated levels of PTH and calcium, and/or palpable neck mass. In our case, diagnosis was based principally on histopathological examination together with clinical presentation, biochemical profile, and imaging studies. Resection of the tumor remains the treatment of choice.

Microstructural and functional connectivity changes of decision-related brain networks in end-stage kidney disease patients undergoing peritoneal dialysis.

We aimed to explore changes in decision-related brain microstructure, brain functional activities, and functional connectivity, and their correlations with cognitive function in end-stage kidney disease (ESKD) patients undergoing peritoneal dialysis (PD). Furthermore, the impact of dialysis on these changes was examined. Thirty ESKD patients undergoing PD, 20 chronic kidney disease (CKD) stage 5 patients without dialysis (predialysis CKD stage 5), and 30 healthy controls (HC) were recruited for the study. Various assessments have been conducted, including neuropsychological scale testing, decision-related behavioral tests, voxel-based morphometry, and functional magnetic resonance imaging. Compared to the HC group, PD patients showed decreased functional activation and gray matter volume in multiple decision-related brain areas, including the ventromedial prefrontal cortex (vmPFC), orbitofrontal cortex (OFC), and anterior cingulate cortex (ACC) (p < 0.05, false discovery rate-corrected). The default mode network (DMN) and salience network (SAN) were the primary brain regions that showed decreased functional connectivity to the vmPFC and ACC. Additionally, compared to the predialysis group, the PD group showed enhanced brain activation in decision-related brain regions such as the ACC, vmPFC, and insula. Though PD and predialysis CKD stage 5 patients performed poorly in the neuropsychological and Iowa Gambling Task (IGT), there was no significant difference between the two groups. The structure and function variabilities of the vmPFC were correlated with IGT and Montreal Cognitive Assessment score, and the activation of OFC was negatively associated with blood creatinine, cystatin, and parathyroid hormone levels. In summary, PD can change the structure and function of decision-related brain circuits (vmPFC-OFC-ACC) and reduce integration within DMN and SAN, which is correlated with cognitive function and clinical features. Moreover, our findings may suggest the comparable capability of PD in preserving one's cognitive function and disease progression. Multimodal neuroimaging based on structure and function can provide more objective information for the early diagnosis and intervention of cognitive impairment in ESKD patients.

Efficacy of Radiofrequency Ablation-Guided by Ultrasound in Primary Hyperparathyroidism: A Systematic Review and Meta-Analysis.

Radiofrequency ablation guided by ultrasound (RFA-USG) is an alternative treatment for primary hyperparathyroidism (PHPT) patients. Despite showing accurate precision and minimal invasion, its efficacy remains questionable. We searched PubMed, Embase, Scopus, Cochrane Library, Portal Regional da Biblioteca Virtual em Saúde (BVS), Web of Science databases for randomized controlled trials (RCTs) and observational studies evaluating RFA-USG in PHPT patients. Statistical analysis was performed with R software, version 4.4.3. Eight studies were included with 208 patients with PHPT undergoing RFA-USG treatment. After 3 months of treatment, parathyroid volume was 0.31 mL (0.16-0.61), Parathyroid hormone (PTH) level was 60.71 pg/mL (53.87-68.42), and calcium level was 5.43 mEq/L (2.63-11.23). The occurrence of hoarseness among the patients was 4.4% (1.64-11.02). RFA-USG is safe for PHPT patients, with associated parathyroid volume reduction and decrease in PTH. However, further study is needed to compare RFA-USG to the gold standard of surgery for PHPT.

Risk factors for developing osteoporosis in diabetic kidney disease and its correlation with calcium-phosphorus metabolism, FGF23, and Klotho.

The progression of diabetic kidney disease (DKD) affects the patient's kidney glomeruli and tubules, whose normal functioning is essential for maintaining normal calcium (Ca) and phosphorus (P) metabolism in the body. The risk of developing osteoporosis (OP) in patients with DKD increases with the aggravation of the disease, including a higher risk of fractures, which not only affects the quality of life of patients but also increases the risk of death. To analyze the risk factors for the development of OP in patients with DKD and their correlation with Ca-P metabolic indices, fibroblast growth factor 23 (FGF23), and Klotho. One hundred and fifty-eight patients with DKD who were admitted into the Wuhu Second People's Hospital from September 2019 to May 2021 were selected and divided into an OP group (n = 103) and a normal bone mass group (n = 55) according to their X-ray bone densitometry results. Baseline data and differences in Ca-P biochemical indices, FGF23, and Klotho were compared. The correlation of Ca-P metabolic indices with FGF23 and Klotho was discussed, and the related factors affecting OP in patients with DKD were examined by multivariate logistic regression analysis. The OP group had a higher proportion of females, an older age, and a longer diabetes mellitus duration than the normal group (all P < 0.05). Patients in the OP group exhibited significantly higher levels of intact parathyroid hormone (iPTH), blood P, Ca-P product (Ca × P), fractional excretion of phosphate (FeP), and FGF23, as well as lower estimated glomerular filtration rate, blood Ca, 24-hour urinary phosphate excretion (24-hour UPE), and Klotho levels (all P < 0.05). In the OP group, 25-(OH)-D3, blood Ca, and 24-hour UPE were negatively correlated with FGF23 and positively correlated with Klotho. In contrast, iPTH, blood Ca, Ca × P, and FeP exhibited a positive correlation with FGF23 and an inverse association with Klotho (all P < 0.05). Moreover, 25-(OH)-D3, iPTH, blood Ca, FePO4, FGF23, Klotho, age, and female gender were key factors that affected the lumbar and left femoral neck bone mineral density. The Ca-P metabolism metabolic indexes, FGF23, and Klotho in patients with DKD are closely related to the occurrence and development of OP.

Effects of Consuming Pulsed UV Light-Treated Pleurotus citrinopileatus on Vitamin D Nutritional Status in Healthy Adults.

Vitamin D, essential for growth and health, is often deficient in Taiwan despite abundant sunlight. Plant-derived vitamin D2 (ergocalciferol) is bioavailable, environmentally friendly, and cost-effective. This study evaluated the efficacy of enhancing Pleurotus citrinopileatus (PC) mushrooms' vitamin D2 content through pulsed ultraviolet (PUV) light and its impact on vitamin D status in humans. In a four-week randomized parallel trial, 36 healthy participants were assigned to three groups: a control group, a group consuming 10 g/day PUV-treated PC (PC-10 g), and a group consuming 100 g/day PUV-treated PC (PC-100 g). Blood samples collected pre- and post-intervention measured serum 25(OH)D2, 25(OH)D3, and biochemical parameters. After four weeks, serum 25(OH)D2 levels significantly increased in the PC-10 g group (1.47 ± 1.42 ng/mL to 9.50 ± 7.10 ng/mL, p = 0.001) and in the PC-100 g group (1.94 ± 2.15 ng/mL to 21.82 ± 16.75 ng/mL, p = 0.002), showing a 10.2-fold rise. The PC-100 g group also experienced a 37.6% reduction in serum intact parathyroid hormone (I-PTH) levels (26.26 ± 9.84 pg/mL to 16.38 ± 5.53 pg/mL). No adverse effects were reported. PUV-treated PC mushrooms significantly increase serum 25(OH)D2 levels and reduce I-PTH, particularly at higher doses. These findings underscore the potential of vitamin-D-enriched PC as a sustainable, fungi-derived food source for addressing vitamin D deficiency.

Does Parathyroid Autotransplantation Prevent Hypoparathyroidism after Thyroid Surgery?

To assess the impact of parathyroid gland autotransplantation on the restoration of parathyroid function in patients who are hypoparathyroid after thyroidectomy. Hypoparathyroidism post-thyroidectomy arises when all parathyroid glands are devascularized or injured. Autotransplantation of compromised parathyroids aims to preserve their function and prevent permanent hypoparathyroidism. Despite routine use, comprehensive evidence on the efficacy of parathyroid autotransplantation remains limited. A retrospective analysis was conducted on 549 patients who underwent total or completion thyroidectomy from December 2015 to June 2023. Surgical outcomes of patients with and without parathyroid autotransplantation were compared. A subgroup analysis included patients with post-anesthesia care unit (PACU) parathyroid hormone (PTH) levels below 10 units. Statistical analyses included the Chi-squared test and multivariable analysis. Of the 549 patients, 152 (27.7%) had parathyroid autotransplantation and 397 (72.3%) did not. The groups were similar in demographics and underlying thyroid etiologies. No significant difference was found in intraoperative parathyroid identification rates (P=0.25). Postoperatively, autotransplanted patients had a higher incidence of transient symptomatic hypocalcemia at 2 weeks (38.0% vs. 19.3%, P<0.001). Multivariable regression showed a higher frequency of postoperative transient hypocalcemia with autotransplantation (IRR=1.90, 95% CI: 1.42-2.54, P<0.001). Among patients with PACU PTH<10 units, recovery rates of parathyroid function were similar between treatment groups (82.2% vs. 82.5%, P=0.46). Long-term follow-up showed comparable low incidence of parathyroid insufficiency in both groups (5.3% vs. 3.8%, P=0.46). Parathyroid autotransplantation does not enhance recovery in hypoparathyroid patient's post-thyroidectomy and does not significantly alter outcomes among patients with PACU PTH<10 .

Cinacalcet Improves Erythropoietin Resistance in Patients with Secondary Hyperparathyroidism Receiving Dialysis Treatment.

Chronic Kidney Disease (CKD) is recognized as a major global public health problem. Dialysis is the mainstay of treatment for patients with end-stage renal disease and can prolong survival in patients with CKD. As patient survival increases, the treatment of complications becomes more important. CKD-mineral and bone disorders (CKD-MBD) and renal anemia are common complications in patients with CKD. Cinacalcet is a calcimimetic for the treatment of Secondary Hyperparathyroidism (SHPT) in adult dialysis patients, which regulates the synthesis and secretion of parathyroid hormone by increasing the sensitivity of calcium-sensitive receptors. This retrospective study evaluated the efficacy of cinacalcet in dialysis patients. Forty-seven patients on dialysis with elevated parathyroid hormone were included. The selected patients have regular follow-up visits in our outpatient clinic and regular use of cinacalcet for no less than 6 months. During the 6-month efficacy evaluation phase, cinacalcet not only reduced the levels of the intact parathyroid hormone (iPTH, P ≤ 0.05), serum calcium (P ≤ 0.01), and Ca×P (P ≤ 0.05) but also reduced weekly erythropoietin dosage (P ≤ 0.01) and erythropoietin resistance index (ERI, P ≤ 0.05). While controlling SHPT in patients with CKD, cinacalcet reduced EPO resistance and improved renal anemia. In conclusion, cinacalcet not only decreased the levels of the iPTH, serum calcium, and Ca×P but also reduced weekly EPO dosage and ERI levels. Controlling SHPT in patients with CKD, cinacalcet also reduced ERI and improved renal anemia.

Determinants of Severe Hypocalcemia After Parathyroidectomy in Patients with End-Stage Kidney Disease and Renal Hyperparathyroidism: A Retrospective Cohort Study.

Background: Parathyroidectomy (PTX) is generally curative in renal hyperparathyroidism (RHPT) that is refractory to medical treatment in end-stage kidney disease (ESKD) patients. Severe hypocalcemia is a common complication of PTX and results in increased monitoring, interventions, lengths of stay, and costs of care. This study aimed to find the determinants and cutoff values of the biochemical determinants, if any, for severe post-operative hypocalcemia after PTX in adult patients with ESKD. Methods: Severe post-operative hypocalcemia was defined as a lowest adjusted serum calcium level < 2 mmol/L during a hospitalization stay following PTX. Receiver operating curves (ROCs) with area under the curve (AUC) values for pre-operative intact parathyroid hormone (iPTH) and pre-operative alkaline phosphatase (ALP) levels against hypocalcemia were used to determine cutoffs. Generalized linear models using Poisson regression with robust error variance were used to estimate the relative risk of severe post-operative hypocalcemia. Results: In total, 75 patients (38 women, 50.7%) with a mean age of 53.8 ± 11.4 years were enrolled; 43 (57%) patients developed severe hypocalcemia post-PTX and had higher pre-operative serum iPTH and ALP levels, as well as a significantly longer hospitalization post-operation (10.5 vs. 4.3 days, p =< 0.001). A pre-operative iPTH level of >166 pmol/L had an AUC-ROC of 0.73 and 72% sensitivity and 73% specificity, respectively, in predicting severe post-operative hypocalcemia with a relative risk of 2.00 [95% CI 1.27-3.33, p = 0.003]. Conclusions: A pre-operative iPTH level > 166 pmol/L is a strong risk predictor for post-operative severe hypocalcemia. Pre-emptive interventions in this high-risk group could potentially result in a reduced length of stay and lower acuity of care.

Assessment of ICG fluorescence in identification and preservation of parathyroid glands in thyroid surgeries and correlation with postoperative parathormone and serum calcium levels.

Intraoperative parathyroid gland (PG) localization remains challenging during thyroid surgeries, contributing to postoperative hypocalcemia and hypoparathyroidism. This study assessed the efficacy of indocyanine green (ICG) fluorescence in identifying and preserving PGs during thyroid surgeries and its correlation with postoperative outcomes. This ambispective observational study included 57 patients undergoing thyroid surgeries using ICG and compared outcomes with 56 historical controls. ICG was administered intravenously in two 5 mg boluses. Parathyroid identification rates, fluorescence intensity, and postoperative calcium and parathormone levels were assessed. Fluorescence intensity was qualitatively scored on a 1-3 scale. ICG significantly improved PG identification (92.5% vs 69.3% with white light alone). Postoperative hypocalcemia occurred in 22.81% of ICG patients compared to 39.29% in controls (p = 0.045). Hypoparathyroidism rates were 10.53% and 32.14% respectively (p = 0.005). Higher fluorescence intensity (FI) correlated with lower risk of postoperative hypocalcemia (p = 0.026) and combined hypocalcemia and hypoparathyroidism (p = 0.046). Considering both FI 2 and 3 as positive yielded 100% sensitivity and 85.7% accuracy. When only FI 3 was considered positive, sensitivity was 78.4%, specificity was 50%, and accuracy was 69.4%. ICG fluorescence is a safe and effective tool for enhancing PG identification and preservation in thyroid surgeries, significantly reducing postoperative hypocalcemia and hypoparathyroidism. It also helps in confirming the vascularity of the PGs post thyroidectomy. Fluorescence intensity of preserved PGs, rather than quantity, better predicts postoperative outcomes. These findings support the integration of ICG fluorescence imaging and the application of our methodology in thyroid surgeries to improve postoperative results.

Significance of Serum Magnesium in Parathyroid Hormone Level in Patients with Chronic Kidney Disease.

In chronic kidney disease (CKD) patients, elevated parathyroid hormone (PTH) is linked to cardiovascular mortality and morbidity. Levels of PTH are influenced by serum phosphate (P) and calcium (Ca), but little is known about the impact of magnesium (Mg) on PTH. Hence, this study investigated the relationship between PTH and Mg in peritoneal dialysis (PD) patients and non-dialysis patients from three hospitals in China. This cross-sectional study included 446 chronic kidney disease stage 5 (CKD5) patients from three hospitals in southern China. PTH was naturally transformed to Ln_PTH for analysis. The chi-square test, Pearson correlation analysis, hierarchical regression analysis, and t-test were used to explore the relationships between Ln_PTH and gender, diabetes history, Mg, P, Ca, albumin (Alb), red blood cells (RBC), hemoglobin (Hb), white blood cells (WBC), and platelet (Plt). Patients with diabetes mellitus (DM) had lower levels of Ln_PTH in PD (P<0.05) and non-dialysis (P>0.05) patients. Ln_PTH levels were negatively associated with Mg and Ca but positively associated with P and Alb in PD patients (all P<0.05). Ln_PTH levels were negatively associated with age but positively associated with P in non-dialysis patients (all P<0.05). This study demonstrates the negative effect of Mg and diabetes on Ln_PTH levels in CKD5 patients.

Impact of lung ultrasound-guided therapeutic approach on haemodialysis treatment in patients with ischemic heart failure

&amp;lt;p&amp;gt;&amp;lt;strong&amp;gt;Aim&amp;lt;/strong&amp;gt; Lung ultrasound (LUS) can be used for an assessment of volume overload in patients with end-stage kidney disease (ESKD) and those undergoing dialysis. The aim of this study was to analyse whether the initial use of LUS in evaluating volume status could benefit patients by optimizing haemodialysis treatment and improving their clinical status.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Methods&amp;lt;/strong&amp;gt; The study included 50 haemodialysis patients in stage V of ESKD with the diagnosis of ischaemic heart failure with reduced (HFrEF) or midrange ejection fraction (HFmrEF). The assessment of volume status was verified solely by LUS (along with the analysis of B lines as measures of volume status). The specified laboratory parameters were performed initially, after three, and after six months.&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Results&amp;lt;/strong&amp;gt; The number of B-lines on LUS were decreased during the six-month follow-up compared to baseline, indicating a reduction in volume overload due to the LUS-guided protocol. Statistically significant differences were observed in the average creatinine (p=0.001) and parathormone (PTH) (p=0.003) levels over the six-month monitoring period. Significant differences were also noted in triglyceride (p=0.000) and potassium (p=0.02) levels. No significant differences were found in the values of other monitored parameters.&amp;amp;nbsp;&amp;lt;br /&amp;gt;&amp;lt;strong&amp;gt;Conclusion&amp;lt;/strong&amp;gt; In haemodialysis patients diagnosed with heart failure, LUS can aid the achievement of a more efficient volume reduction by decreasing B-lines, which are indicative of congestion. Our study also demonstrated beneficial effects of LUS on potassium and parathormone levels.&amp;lt;/p&amp;gt;

Unlocking the mysteries of n-oxPTH: implications for CKD patients.

Parathyroid hormone (PTH) is a pivotal hormone that regulates serum calcium and phosphate and is closely associated with higher risk of cardiovascular disease and mortality in patients with chronic kidney disease (CKD). PTH can undergo oxidation at methionine 8 and methionine 18 of the molecule. This oxidation process leads to a lower binding affinity to the PTH receptor due to molecular refolding, particularly for PTH oxidized at methionine 8. Although, the oxidation of PTH has been reported for several decades, it is only recently that a method has been developed to detect non-oxidized PTH (n-oxPTH) levels. The utilization of this assay enables the precise detection of n-oxPTH levels and facilitates the evaluation of their correlation with poor prognosis in patients with CKD. However, the current available clinical research findings indicate that n-oxPTH does not demonstrate clinical superiority over iPTH. Here, we provide a comprehensive review on the mechanism of PTH oxidation, the n-oxPTH assay method, and its correlation with iPTH and clinical outcomes.

US-Guided Thermal Ablation for Secondary Hyperparathyroidism: A Prospective Multicenter Study.

Background Interest in microwave ablation (MWA) and radiofrequency ablation (RFA) use for treating secondary hyperparathyroidism (SHPT) is rising; however, ablation outcomes in patients with SHPT are not well characterized. Purpose To assess the response of parathyroid hormone (PTH), calcium, phosphorus, and alkaline phosphatase (ALP) levels to US-guided parathyroid MWA and RFA and the safety of these treatments in participants with SHPT. Materials and Methods This prospective multicenter cohort study, conducted from September 2017 to March 2022, included participants with SHPT. The primary end point was the proportion of participants achieving the target PTH level (≤585 pg/mL). The secondary end points included PTH, calcium, phosphorus, and ALP levels before ablation and time points for follow-up assessments after ablation (2 hours, 1 day, 1 month, 3 months, and 6 months, and then every 6 months) and complications and technical success rates. Mixed-effects logistic regression models were used to identify factors associated with treatment failure. Results A total of 215 participants (median age, 53 years [IQR, 43-60 years]; 109 [50.7%] male participants) were evaluated, and 183 (85.1%) achieved target PTH levels. Compared with baseline levels, there was an 85.9%, 6.3%, 15.3%, and 37.4% reduction in PTH, calcium, phosphorus, and ALP levels at 24 months after ablation, respectively. For major complications, one (0.5%) participant experienced persistent hoarseness, and severe hypocalcemia (<1.87 mmol/L) was present in 74 (34.4%) participants. After adjustments, predictors associated with treatment failure included the preablation PTH level (adjusted odds ratio [OR], 3.78; 95% CI: 1.19, 12.04; P = .03), maximum tumor volume (adjusted OR, 5.02; 95% CI: 1.74, 14.53; P = .003), and number of glands ablated (adjusted OR, 0.32; 95% CI: 0.11, 0.98; P = .046). The prediction model showed good discrimination ability in the development and validation cohorts (area under the receiver operating characteristic curve, 0.78 [95% CI: 0.66, 0.90] and 0.73 [95% CI: 0.55, 0.91], respectively). Conclusion US-guided thermal ablation techniques were effective and safe treatments in participants with SHPT because they effectively reduced PTH, calcium, phosphorus, and ALP levels. © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Gemmete in this issue.

Effects of low phosphorus diets on phosphorus balance and plasma concentrations of 25-hydroxyvitamin D3, and carboxy-terminal collagen crosslinks during the transition period in dairy cows.

Our aim was to determine the effects of P intake on P balance, serum parathyroid hormone (PTH) levels and bone resorption during the final 4 weeks prepartum and the first 8 weeks of lactation. Sixty pregnant multiparous Holstein Friesian dairy cows were assigned to a randomized block design with repeated measurements and dietary treatments arranged according to a 2 × 2 factorial design. The experimental diets contained 3.6 (high phosphorus, HP) or 2.2 (low phosphorus, LP) g P/kg DM during the dry period (Dry-HP and Dry-LP, respectively) and 3.8 or 2.9 g P/kg DM during 56 d after calving (Lac-HP and Lac-LP, respectively). The level of dietary P, expressed as g/kg DM, of Dry-LP was 18% greater than recommended by the Dutch Central Bureau for Livestock feeding, while the P content of Lac-LP was, across the 8 wks of lactation, 24% lower than recommended. Both P intake and fecal P excretion decreased in the dry period to increase again in subsequent lactation. Cows fed high dietary P excreted more P in the feces than cows fed low dietary P pre- and postpartum. Cows in both Dry-HP and Dry-LP were in positive P balance in the dry period. Cows in both Lac-LP and Lac-HP were in negative P balance after calving, with the negative P balance being more pronounced in Lac-LP than in Lac-HP. Serum concentrations of PTH, and apparent total-tract OM and NDF digestibility, were neither affected by any 2-way or 3-way interaction between time of sampling and dietary treatments nor by the P concentration of the experimental diets during the pre- and postpartum period. Before calving, serum carboxy-terminal collagen crosslinks (CTX) concentrations were basically similar between Dry-HP and Dry-LP. After calving, serum CTX concentrations increased, with a more pronounced increase when Lac-LP was fed compared with Lac-HP. The results suggest that when feeding diets containing low P (2.9 g/kg DM) postpartum, cows excreted less P in the feces than at recommended dietary P (3.8 g P/kg DM) without negative impact on OM and NDF digestibility. The increase in serum CTX concentrations, without increasing serum PTH concentrations upon feeding low P, indicates a prominent role of bone resorption to meet P demands in the first 8 weeks postpartum. The present trial focused on the final 4 weeks of gestation and the subsequent 8 weeks of lactation, but long-term effects of low dietary P during early lactation on serum PTH and on bone P dynamics in mid and late lactation need to be further investigated.

Increase in serum parathyroid hormone level intraoperatively after parathyroidectomy for primary hyperparathyroidism.

To evaluate the significance of increased of intraoperative parathyroid hormone(IOPTH) 10min after parathyroidectomy in primary hyperparathyroidism. All patients underwent parathyroidectomy were retrospectively included. Following the results of IOPTH, three groups were defined: Group 1: increased of IOPTH, Group 2: <50% decreased of IOPTH, and Group 3: >50% decreased of IOPTH. Unilateral approach was performed and shifted to bilateral neck exploration(BNE) when indicated. There were single adenoma, double adenomas, and hyperplasia in 84%, 5%, and 11% of cases respectively. We noted that 100%, 80%, and 4% of patients had a polyglandular diseases in Groups 1, 2, and 3 respectively. Double adenoma and hyperplasia were present in 55%, and 45%, 22%, and 58%, 1%, and 3% in Groups 1, 2, and 3 respectively. Female patients represented 55%, 71%, and 81% of patients in Groups 1, 2, and 3 respectively. Cure rate was 99%. Patients with increased of IOPTH level 10min after parathyroidectomy had a polyglandular diseases in 100% of cases and needed BNE.

Association of Obesity on Rates of Multiglandular Disease in Primary Hyperparathyroidism: A Cohort Study.

Primary hyperparathyroidism (PHPT) is more prevalent in populations with obesity. Obesity-related vitamin D deficiency may affect rates of multigland parathyroid disease, but this relationship is less clear. We aimed to assess the relationship between obesity and the rate of multigland disease in patients with PHPT. Patients who underwent parathyroidectomy from 2015 to 2021 for sporadic PHPT at a tertiary center were retrospectively analyzed. The primary outcome was rates of single-gland versus four-gland parathyroid hyperplasia in relation to obesity. Secondary outcomes included analysis of serum biochemistries [parathyroid hormone (PTH), calcium, 25(OH) vitamin D (25OHD)] before and 6mo postoperatively based on obesity classification: no obesity (body mass index [BMI] <30kg/m2), Class 1 (BMI 30-34.9kg/m2), Class 2 (BMI 35-39.9kg/m2), Class 3 (BMI ≥40kg/m2). Statistical analysis was performed using Chi-square, Mann-Whitney U, and Kruskal-Wallis tests where applicable. Of 2634 patients who underwent parathyroidectomy, a total of 1173 had obesity. Obesity did not confer any differences in the proportion of four-gland versus single-gland hyperplasia (25 versus 26%, P=0.79). Compared to patients without obesity, preoperative PTH levels were higher in patients with Class 2 [86 (interquartile range [IQR] 66-118) versus 95 (IQR 70-137) pg/mL, P=0.001] and Class 3 [86 (IQR 66-118) versus 104 (76-150) pg/mL, P<0.001] obesity. Conversely, 25OHD before surgery was lower across obesity subclasses [no obesity: 36.0 (25.3-49.3), Class 1: 32.5 (24.0-46.0), Class 2: 32.9 (22.0-44.6), Class 3: 31.7 (20.4-45.0) ng/mL, P<0.001]. Postoperative PTH and 25OHD improved in all cohorts. No calcium-related differences were found among patients based on obesity classification. Obesity is not associated with an increased rate of four-gland hyperplasia in patients with PHPT, and therefore should not alter surgical management. The levels of 25OHD in patients with obesity should be monitored for vitamin deficiency preoperatively and postoperatively.

Intraoperative Parathyroid Hormone Monitoring Criteria in Primary Hyperparathyroidism

Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy. To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT. A bayesian diagnostic test accuracy network meta-analysis (DTA-NMA) was performed, in which peer-reviewed citations from January 1, 1990, to July 22, 2023, were searched for in MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL. All full-text study designs that evaluated any IOPTH monitoring criteria as a diagnostic test were included in this meta-analysis. Any studies evaluating adult patients diagnosed with PHPT undergoing parathyroidectomy were also included. The reference standard used in this study was normalization of calcium and/or parathyroid hormone levels within 1 year of surgery. This DTA-NMA was reported in accordance with the applicable Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guidelines. Two reviewers evaluated all abstracts and full-text articles using a piloted extraction form. A third author resolved any conflicts. There are no published Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) resources for DTA-NMA. The following conventional monitoring criteria were included: Halle, Miami, Rome, Vienna, and PTH normalization, and the following modified criteria were included: Miami and PTH normalization, modified Miami, and modified Vienna. A bayesian hierarchical DTA-NMA model with corresponding 95% credible intervals (CrIs) was used to describe the pooled diagnostic characteristics of the evaluated IOPTH monitoring criteria. Main outcomes included pooled diagnostic test properties, including sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and diagnostic odds ratio. A total of 72 studies, which included 19 072 patients, met the inclusion criteria. Sixty-nine studies (95.8%) investigated classic PHPT. In PHPT, the Miami criteria were investigated most often and had the best diagnostic properties (diagnostic odds ratio, 60.00 [95% CrI, 32.00-145.00]) when compared to other conventional criteria. Moreover, the modified Miami criteria, which measures a postexcision IOPTH level 15 minutes or more postexcision of all hyperfunctioning parathyroid tissue, were the overall best criteria (diagnostic odds ratio, 79.71 [95% CrI, 22.46-816.67]). There was a low risk of study bias and no publication bias. The results of this meta-analysis suggest that surgeons should use the modified Miami criteria when performing IOPTH-guided surgery for patients with PHPT because these criteria optimize intraoperative diagnostic accuracy by minimizing unnecessary neck exploration and revision surgery rates.