Parathyroidectomy For Hyperparathyroidism Research Articles

The Importance of Level of Drop of Intra-operative Parathyroid Hormone in Predicting Recurrence After Parathyroidectomy for Primary Hyperparathyroidism

Background: During parathyroidectomy for hyperparathyroidism, intraoperative parathyroid hormone (IOPTH) levels are used to confirm excision of parathyroid adenoma. A drop in IOPTH level of 50% or drop to a normal level is associated with a high cure rate. However, there are still a number of patients who fit this criterion who have recurrent hyperparathyroidism. The authors hypothesize that a drop in PTH to a level below 4 pmol/l (37.72 pg/mL) rather than just a 50% drop would decrease the rate of recurrence disease. Methods: The authors conducted a retrospective review of consecutive patients who underwent surgery for parathyroid adenoma between March 2015 and December 2018. Parathyroidectomy was performed with curative parathyroidectomy defined as drop in IOPTH below 4 pmol/l (37.72 pg/mL) after 10-15minutes from excision (2-3 half-life periods of PTH) of abnormal Parathyroid gland. Results: 72 patients were identified who underwent Parathyroidectomy for primary hyperparathyroidism during the study period. Post resection IOPTH levels below 4 pmol/l correctly predicted an operative success rate near 100% in the cohort. Contrarily IOPTH level drop more than 50% but above a level of 4 pmol/l (9 cases) was associated with an additional unidentified Parathyroid adenoma in 7 cases. Conclusions: Post parathyroidectomy drop in IOPTH level below 4 pmol/l appears to be more predictive of successful treatment for primary hyperparathyroidism related to parathyroid adenoma compared to standard criteria.

Intraoperative parathyroid hormone monitoring in parathyroidectomy for hyperparathyroidism: a protocol for a network meta-analysis of diagnostic test accuracy.

Intraoperative parathyroid hormone (iPTH) monitoring is standard-of-care in the surgical management of hyperparathyroidism. It involves real-time determination of circulating PTH levels to guide parathyroid gland excision. There exists several iPTH monitoring criteria, such as the Miami criteria, and a lack of standardization in the timing of post-parathyroid gland excision samples. We present a protocol of a systematic review and network meta-analysis of diagnostic test accuracy to identify the iPTH criteria and post-gland excision timepoint that best predicts surgical cure in hyperparathyroidism. The database search strategy will be developed in conjunction with a librarian specialist. We will perform a search of Medline (Ovid), EMBASE (Ovid), CINAHL, Cochrane Collaboration, and Web of Science from 1990-present. Studies will be eligible if they include adult patients diagnosed with hyperparathyroidism who undergo parathyroidectomy with iPTH monitoring. We will only include studies that report diagnostic test properties for iPTH criteria and/or post-excision sampling timepoints. All screening, full-text review, data extraction, and critical appraisal will be performed in duplicate. Critical appraisal will be performed using QUADAS-2 instrument. A descriptive analysis will present study and critical appraisal characteristics. We will perform evaluation of between-study heterogeneity using I2 and Cochrane Q and where applicable, we will perform sensitivity analysis. Our network meta-analysis will include Bayesian hierarchical framework with random effects using multiple models. Ethics approval is not required. This proposed systematic review will utilize a novel Bayesian network meta-analysis model to help standardize iPTH monitoring in hyperparathyroidism, thereby optimizing patient outcomes and healthcare expenditures.

Early Bone Pain Relief a Reliable Indicator of Successful Para Thyroidectomy - A Comparative Prospective Study

Aim: To evaluate early bone pain relief as anindicatorof successful Para thyroidectomy in hyperparathyroidism. Methodology: A prospective, comparative study was conducted at the Department of Surgery, Jinnah Postgraduate Medical Center, between March 2022 and August 2022. All patients with symptoms of hyperparathyroidism, confirmed with increased intact parathyroid hormone and elevated levels of calcium onpresentation were included in the study. Patients were classified as primaryhyperparathyroidism when the MIBI scan detected an adenoma with clinical features ofhypercalcemia and increased PTH whereas, patients were diagnosed with secondaryhyperparathyroidism if patient presented with renal failure, persistently high levels of PTH, as well as hypocalcemia. All patients with primary hyperparathyroidism underwentexcision for adenoma while patients with secondary hyperparathyroidism underwenttotal Para thyroidectomy and auto transplantation. Visual analogue scale was used toassess bone pain at presentation and 12 to 24 hours after procedure, and then six-weeks atfollow-up. Change in symptomatology was observed and compared between the twosets of patients. Results: A total of fourteen primary hyperparathyroidism cases were observed in ourcenter. 13 patients presented with bone pain and deformity, three of these patients were operated for renal stones, three patients had depressive symptoms. The calcium ranged from 12-15mg/dl with adenoma ranging from 1.0 cm to 4.0 cm.Three cases were diagnosed as secondary hyperparathyroidism, secondary to renal failure. Total Para thyroidectomy was done to remove all four parathyroid glands with subsequent auto transplant. All patients had hypo calcemic signs postoperative, which was relieved after calcium transfusion for two days followed by oral. Conclusion: In all patients, irrespective of the cause of the hyperparathyroidism, early pain reliefwas correlated with successful parathyroid surgery. Keywords: Parathyroid, hyperparathyroidism, primary, secondary, PTH, calcium, pain

Severe Refractory Hypocalcemia after Parathyroidectomy for Hyperparathyroidism and Parathyroid Adenoma in a Patient with Prior Bariatric Surgery: A Rare Case Report

Hypocalcaemia is a common but transient complication post Parathyroid surgery. In patients who have gone through bariatric surgery including Roux-En-Y the risk increases further. We present a challenging case report of a patient with history of RYGB who underwent parathyroidectomy and consequently developed refractory hypocalcaemia. Hypocalcaemia was managed conservatively initially but subsequently required higher doses of both intravenous and oral calcium along with teriparatide. Patients post Bariatric surgery including those who have undergone Roux-en-Y who are proceeding with Parathyroid procedures should be followed up closely for hypocalcaemia.

SAT-353 Familial Hyperparathyroidism - Due to a Rare Genetic Mutation

Introduction: Hyperparathyroidism occurs most commonly in middle age patients, predominantly in women. It can be caused by parathyroid adenoma, hyperplasia or parathyroid carcinoma. Genetic predisposition can be found in about 10% of primary hyperparathyroidism due to certain gene mutations. This case emphasizes the importance of taking a detailed family history when patients present with hyperparathyroidism at a young age, so that familial hyperparathyroidism, if present, can be detected and relatives screened.Clinical case: A 26 y.o. male presented with symptoms of fatigue and polydipsia for several years.He was noted to have a serum calcium of 12.4 mg/dL(8.5–10.5), with parathyroid hormone of213 pg/ml (15–65). He denied any history of kidney stones, fractures and no palpable neck masses. The patient’s family history was significant for his paternal half-sister who had parathyroidectomy for hyperparathyroidism at 20yrs old and paternal grandmother died of parathyroid cancer in her 50s. The patient’s father died of pancreatic cancer at 41yrs old. A neck ultrasound revealed a mass posterior to the left inferior thyroid. A Sestamibi parathyroid scan revealed a parathyroid adenoma at the posteroinferior aspect of the left hemithyroid. Labs for free metanephrines and normetanephrine, prolactin and gastrin levels were all normal.Due to his young age and the possibility of having familial hyperparathyroidism, he underwent bilateral neck exploration and parathyroidectomy, with removal of his left inferior, right superior, left superior parathyroid glands and left upper thymus. Surgical pathology revealed, hypercellular parathyroid tissue. Post operatively, his calcium and vitamin D remained within the normal range.Genetic studies revealed a mutation in the parafibromin gene - CDC73 (also called HRPT2), a tumor suppressor gene, which is on chromosome 1q25. The patient currently has 6 children ranging from age 5 months to 6 years. He was advised to have his children tested any time from age 7 years for the gene mutation.The patient has remained stable 4yrs post operatively, with normal calcium and PTH levels. He does not have any history of jaw tumor. He never had an ultrasound kidney done. He is being monitored with yearly lab tests. Conclusion: CDC73 gene mutation-associated disorders are inherited as an autosomal dominant fashion, with variable penetrance. This gene mutation can be found in conditions such as hyperparathyroidism jaw tumor, familial hyperparathyroidism and parathyroid cancer.Reference:1.CDC73-Related Disorders: Clinical Manifestations and Case Detection in Primary Hyperparathyroidism. J Clin Endocrinol Metab. 2017 Dec 1;102(12):4534–4540.

SUN-269 Indications and late results of parathyroidectomy for hyperparathyroidism in patients under hemodialysis : A single center experience (about 18 cases)

SUN-269 Indications and late results of parathyroidectomy for hyperparathyroidism in patients under hemodialysis : A single center experience (about 18 cases)

Normocalcemic tetany after parathyroidectomy for hyperparathyroidism

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Duodenal Gastrinoma Associated with Multiple Endocrine Neoplasia Type 1 (MEN1) Detected by Esophagogastroduodenoscopy (EGD), which was buried under Ulcer

A 66-year-old Japanese male was shown to have severe ulcers with hypergastrinemia in the stomach through proximal horizontal part of the duodenum, who complained of dysphagia and vomiting. He suffered from gastric ulcer at 63, proven to have undergone parathyroidectomy for hyperparathyroidism at his 5th decade. Though had no definitely enlarged pituitary detectable by computed tomography (CT), he had slight defects in the visual field and hyperprolactinemia. A diagnosis of MEN1 was entertained. Follow up EGD revealed 5 small sessile submucosal tumors (SMTs) with a central depression or erosion in the duodenal bulb through descending part of the duodenum, which had been obscured beneath ulcers. Demonstrated in the regenerative mucosa by their biopsy were clusters of small tumor cells, which, though considered the tips of neuroendocrine (NE) tumor (NET) lying in the deeper layer, were not large enough to be proven so by immunostaining with the markers in the serial sections, and diffuse hyperplasia of synaptophysin-, chromogranin A- and gastrin-positive NE cells in Brunner glands (BGs), the preneoplastic lesion characteristic of MEN1-associated duodenal gastrinoma, supporting the diagnosis, which was firmly guaranteed by positively elevated glucagon-provoked plasma gastrin. Subtotal stomach-preserving pancreaticoduodenectomy (SSPPD) established the final diagnosis of duodenal gastrinomas graded G1 associated with MEN1, which were shown to be tightly contained in the densely conglomerated hyperplastic BGs. No metastases were detected. This is the first case in the world, in which all the three characteristics of MEN1- associated duodenal gastrinoma were demonstrated by EGD. Difficulty in endoscopically detecting the NET lies in the fact that, in addition to its smallness and deep localization, it might be buried under peptic ulcer at a certain stage of the natural history and that an attempt to biopsy it is hampered by the densely conglomerated barrier of the hyperplastic BGs in some cases.

Nonfunctioning Parathyromatosis after Endoscopic Thyroid Lobectomy via an Axillo-Breast Approach: A Case Report

Parathyromatosis is a rare disease that occurs in the neck and mediastinum as multiple lesions leading to hyperparathyroidism (1, 2). Parathyromatosis is usually divided into 2 types: primary parathyromatosis, which is proliferation of an embryonic remnant, and the more common secondary parathyromatosis, which is a post-surgical growth of retained parathyroid tissues or seeding of parathyroid tissue by capsular rupture of parathyroid adenoma during parathyroidectomy (1, 2). Early diagnosis and treatment of parathyromatosis is important because parathyromatosis also causes recurrent metabolic disorder after a parathyroidectomy for hyperparathyroidism (1-3). We experienced a patient with parathyromatosis without hyperparathyroidism. In this study, we report a case of secondary parathyromatosis after endoscopic thyroidectomy for a presumed thyroid mass via an axillo-breast approach. CASE REPORT

Parathyroid Cryopreservation after Parathyroidectomy: A Worthwhile Practice?

Parathyroid cryopreservation is often utilized for patients having parathyroidectomy. This allows for future autotransplantation if a patient becomes permanently hypocalcemic after surgery. However, the practice of cryopreservation is costly and time-consuming, while the success rate of delayed autotransplantation is highly variable. We sought to determine the rate and outcomes of parathyroid cryopreservation and delayed autotransplantation at our institution to further evaluate its utility. At our institution, 2,083 parathyroidectomies for hyperparathyroidism (HPT) were performed from 2001 to 2010. Of these, parathyroid cryopreservation was utilized in 442 patients (21 %). Patient demographics, preoperative diagnoses, and other characteristics were analyzed, as well as the rate and success of delayed autotransplantation. Of the 442 patients with cryopreservation, the mean age was 55 ± 1 years and 313 (70.8 %) were female. A total of 308 (70 %) had primary HPT, 46 (10 %) had secondary HPT, and 88 (20 %) had tertiary HPT. Delayed autotransplantation of cryopreserved parathyroid tissue was used in 4 (1 %) patients at an average time of 9 ± 4 months after initial surgery. Three of the 4 patients remained hypoparathyroid after this procedure. The single cured patient underwent the procedure only 4 days after the initial parathyroidectomy. Although cryopreservation was used in over one-fifth of patients undergoing parathyroidectomy, the need for parathyroid reimplantation was very low (1 %). Furthermore, the success rate of parathyroid autotransplantation was poor in these patients. Therefore, the continued practice of parathyroid cryopreservation is questionable.

Symptoms of gastroesophageal reflux disease improve after parathyroidectomy

Primary hyperparathyroidism can be associated with symptoms related to GERD, but it is unclear which symptoms of GERD improve after parathyroidectomy. Our goal was to assess prospectively for changes in specific GERD symptoms after parathyroidectomy using a validated questionnaire. Using the GERD health-related quality of life (GERD-HRQL) questionnaire, symptoms of heartburn were prospectively assessed before and 6 months after treatment of hyperparathyroidism with parathyroidectomy. This validated questionnaire includes 10 items, with a Likert scale of 0-5. Scores range from 0 to 45, a lesser score indicates fewer/less severe symptoms. Pre- and postoperative surveys were available for 51 patients. Parathyroidectomy improved the overall questionnaire score (12.5 ± 1.3 vs 4.5 ± 0.9, P < .0001). Overall scores for each question improved after parathyroidectomy, including symptoms of dysphagia (P = .001) and overall satisfaction with symptoms (P < .0001). However, the number of patients taking antireflux medication before and after parathyroidectomy was not substantially different (34 vs 28 patients, P = .17). All symptoms of GERD improved after parathyroidectomy for hyperparathyroidism. Despite the decrease in symptoms, there was not a change in the number of patients who remained on anti-reflux therapy. For patients with symptoms of GERD, a trial off antireflux medications after parathyroidectomy should be considered.

Changes in Swallowing-Related Quality of Life after Parathyroidectomy for Hyperparathyroidism: A Prospective Cohort Study

To prospectively evaluate the impact of parathyroidectomy on swallowing-related quality of life using the Swallowing Quality Of Life (SWAL-QOL) validated outcomes assessment tool. Many patients with primary hyperparathyroidism report nonspecific symptoms, such as fatigue, irritability, cognitive impairment, sleep disturbances, and dysphagia. To date, there have been no prospective studies evaluating swallowing function before and after parathyroid surgery. Patients undergoing parathyroidectomy from September 2007 to January 2009 completed the SWAL-QOL questionnaire before and one year after surgery. Data were collected on demographic and clinicopathologic variables. Comparisons were made to determine the effect of surgery on patients' perceptions of swallowing function. Of 151 eligible patients, 102 (68%) completed the study. The mean patient age was 60 years, and 79% were female. A total of 73 patients (67%) had minimally invasive parathyroidectomies, whereas the remainder had bilateral explorations. In all, 83 patients (81%) had a parathyroid adenoma, 16 patients (16%) had hyperplasia, and 3 patients (3%) had a double adenoma on final pathologic interpretation. Mean preoperative SWAL-QOL scores were <90 for 4 of the 11 domains, indicating the perception of oropharyngeal dysphagia and diminished quality of life. Following parathyroidectomy, significant improvements were demonstrated in eight SWAL-QOL domains. Many patients with parathyroid disease have the perception of abnormal swallowing function. In these patients with symptoms of dysphagia, parathyroid surgery leads to significant improvements in many aspects of swallowing-related quality of life measured by the SWAL-QOL instrument. This study represents the first use of a condition-specific instrument to assess swallowing-related quality of life for patients with parathyroid disease before and after parathyroid surgery.

Can We Better Predict and Treat Urinary Incontinence After Prostatectomy?

No AccessJournal of UrologyEditorial1 Mar 2012Can We Better Predict and Treat Urinary Incontinence After Prostatectomy? Daniel S. Elliott Daniel S. ElliottDaniel S. Elliott Financial interest and/or other relationship with Coloplast. More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.12.027AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Can We Better Predict and Treat Urinary Incontinence After Prostatectomy?." The Journal of Urology, 187(3), pp. 789–790 References 1 : Low annual caseloads of United States surgeons conducting radical prostatectomy. J Urol2009; 182: 2677. Link, Google Scholar 2 : Radical prostatectomy: hospital volumes and surgical volumes - does practice make perfect?. BMC Surg2009; 9: 10. Google Scholar 3 : Role of surgeon volume in radical prostatectomy outcomes. J Clin Oncol2003; 21: 401. Google Scholar 4 : Variations in morbidity after radical prostatectomy. N Engl J Med2002; 346: 1138. Google Scholar 5 : Surgeon experience is strongly associated with biochemical recurrence after radical prostatectomy for all preoperative risk categories. J Urol2008; 179: 2212. Link, Google Scholar 6 : Association between hospital and surgeon radical prostatectomy volume and patient outcomes: a systematic review. J Urol2008; 180: 820. Link, Google Scholar 7 : A systematic review and critique of the literature relating hospital or surgeon volume to health outcomes for 3 urological cancer procedures. J Urol2004; 172: 2145. Link, Google Scholar 8 : Hospital volume and surgical outcomes after elective hip/knee arthroplasty: a risk-adjusted analysis of a large regional database. Arthritis Rheum2011; 63: 2531. Google Scholar 9 : Association between hospital and surgeon procedure volume and outcomes of total hip replacement in the United States Medicare population. J Bone Joint Surg Am2001; 83: 1622. Google Scholar 10 : Operative failures after parathyroidectomy for hyperparathyroidism: the influence of surgical volume. Ann Surg2010; 252: 691. Google Scholar Department of Urology, Mayo Clinic, Rochester, Minnesota© 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 3March 2012Page: 789-790 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel S. Elliott Financial interest and/or other relationship with Coloplast. More articles by this author Expand All Advertisement PDF downloadLoading ...

Parathyroidectomy Markedly Reduces Oxidative Stress in a Patient with Primary Hyperparathyroidism

Parathyroidectomy for hyperparathyroidism has been associated with a survival benefit, but the mechanisms remain unclear. We are reporting on an 88-year-old female patient who had high serum calcium and intact parathyroid hormone levels associated with an enlarged parathyroid gland. A parathyroidectomy was performed due to a diagnosis of primary hyperparathyroidism. After the surgery, there was a marked decrease in the oxidative stress markers, such as the ratios of oxidized to unoxidized albumin and advanced oxidation protein products. These results suggest that parathyroidectomy reduces oxidative stress in patients with primary hyperparathyroidism, which may in part explain the reduced risk for cardiovascular and all-cause mortality after parathyroidectomy.

Reoperative parathyroidectomy: location of missed glands based on a contemporary nomenclature system.

To evaluate and categorize the locations of missed parathyroid glands found during reoperative parathyroidectomy and to determine any factors associated with these locations. Retrospective cohort study. Tertiary referral center. Fifty-four patients who underwent reoperative parathyroidectomy for persistent or recurrent hyperparathyroidism from January 1, 2005, through January 1, 2009. Location of missed parathyroid glands and their association with continuous variables were analyzed using a Kruskal-Wallis test, and associations between gland location and categorical variables were evaluated using the Fisher exact test. Among 54 patients, 50 abnormal parathyroid glands were identified, resected, and classified as follows: 5 (10%) were type A (adherent to the posterior thyroid capsule); 11 (22%), type B (behind the thyroid in the tracheoesophageal groove); 7 (14%), type C (close to the clavicle in the prevertebral space); 3 (6%), type D (directly over the recurrent laryngeal nerve); 9 (18%), type E (easy to identify; near the inferior thyroid pole); 13 (26%), type F (fallen into the thymus); and 2 (4%), type G (gauche, within the thyroid gland). No demographic, biochemical, or pathological factors were significantly associated with gland location. Among the 43 patients followed up for 6 months, 40 (93%) had documented cures. Missed glands after parathyroidectomy for hyperparathyroidism can be found in standard locations in most cases. A standardized nomenclature system based on the regional anatomy and the embryology of the parathyroid glands can guide a systematic exploration for parathyroid adenomas that are not easily identified and facilitate communication about gland locations.

Operative Failures After Parathyroidectomy for Hyperparathyroidism

To determine whether surgical volume influences the cause of operative failures after parathyroidectomy for hyperparathyroidism. The surgical success rate for hyperparathyroidism from high-volume centers exceeds 95%, but some patients have unsuccessful parathyroidectomies. Although operative failure can be due to hyperfunctioning parathyroid glands in ectopic locations, less experienced surgeons may be more likely to miss an abnormal parathyroid in normal anatomic locations, which we describe as "preventable operative failure." We used 2 prospective databases containing over 2000 consecutive patients who underwent parathyroidectomy. We identified 159 patients with persistent/recurrent hyperparathyroidism subsequently cured with additional surgery. The initially failed operations were classified as being performed at high- (>50 cases/yr) or low-volume (<50 cases/yr) hospitals. Hospital volume was obtained from a Wisconsin state database of 89 hospitals, which reported 6336 parathyroid operations during the same decade. Patients who initially failed their operation performed at the high- or low-volume centers were similar with regard to age, laboratory values, gender, and parathyroid weights. Despite a higher incidence of multigland disease (which increases the likelihood of operative failure) in the high-volume group, patients in the low-volume group were more likely to have a missed parathyroid gland in a normal anatomic location (89% vs. 13%, P < 0.0001), and thus a higher proportion of preventable operative failures. Surgical volume influences the failure pattern after parathyroidectomy for hyperparathyroidism. Preventable operative failures are more common in low-volume centers.

Diffuse Dermal Angiomatosis Associated With Calciphylaxis

Diffuse dermal angiomatosis (DDA) is a reactive proliferation of vascular channels within the dermis often associated with atherosclerosis. Based on our observation of a case of calciphylaxis (CP) with extensive DDA, we investigated a new possible association and incidence of DDA in patients with CP. These 2 rare conditions had not been reported previously in the same patient. In a retrospective review of skin biopsies taken between 1988 and 2006, 11 patients with histologically proven CP were identified and the medical records were reviewed. Two cases were excluded due to inadequate specimens for a thorough histologic evaluation. Nine patients with large necrotic plaques/ulcers were included in the study. Associated diseases were end-stage renal insufficiency (n = 7), parathyroidectomy for hyperparathyroidism (n = 3), thromboembolic events (n = 3), hypertension (n = 3), and diabetes mellitus (n = 2). Histologically, all cases had some degree of diffuse dermal proliferation of vascular channels with interstitial expression of CD31, as well as subcutaneous fat necrosis and calcification with medial vascular calcification. The extent of DDA did not correlate with the gravity or severity of disease. Based on our observation, DDA is a common histological finding encountered in the dermis adjacent to necrotizing ulcers in patients with CP.

Outcome of parathyroidectomy for patients with renal disease and hyperparathyroidism: predictors for recurrent hyperparathyroidism

A small group of patients with renal disease-related secondary or tertiary hyperparathyroidism require surgical parathyroidectomy. Among them, 5-20% require further re-exploration and excision of parathyroid tissue because of recurrent disease. The aims of the present study were to review the characteristics and outcomes of patients undergoing parathyroidectomy for renal disease related hyperparathyroidism and to identify the risk factors for recurrent hyperparathyroidism. Review of data from a dedicated head and neck database at Royal Prince Alfred Hospital between 1988 and 2004. There were 115 patients of whom 68 (59%) patients were treated with subtotal parathyroidectomy (STP), 43 (37%) were treated with total parathyroidectomy (TP) and 4 (3%) were treated with TP with autotransplant. Of those, 11 (9.6%) patients developed recurrent hyperparathyroidism (9 had STP, 1 had TP and 1 had TP with autotransplant). On re-exploration, persistent hyperplastic parathyroid tissue was located at the site of partially excised parathyroid gland (64%), autotransplanted parathyroid tissue (9%), anterior mediastinum (18%) and intrathyroidal parathyroid (9%). Predictors for recurrent hyperparathyroidism are STP (P= 0.049), preoperative symptom of calciphylaxis or calcinosis (P= 0.024), elevated preoperative calcium level (P= 0.007) and elevated post-operative PTH levels (P= 0.014). Post-operative PTH levels less than 10 pmol/L has a positive predictive value of 97.5% for cure (P= 0.02). More aggressive surgical approach could be indicated in patients with preoperative hypercalcaemia and calcinosis/calciphylaxis. Post-operative PTH can be utilized as a marker for cure after parathyroidectomy in hyperparathyroidism of renal disease.

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism—Reply

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism—Reply

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism

Elevation of Parathyroid Hormone Levels in Children Who Underwent Parathyroidectomy for Hyperparathyroidism