The re-elevation of parathyroid hormone level after successful operation for primary hyperparathyroidism / 中华普通外科杂志

ABSTRACT

Objective:To explore the probability, influencing factors, and management strategies of the re-increase of parathyroid hormone (PTH) in patients with primary hyperparathyroidism (pHPT) after successful surgery.Methods:A retrospective analysis of the clinical data of 40 pHPT patients treated at Beijing Tsinghua Chang Gung Hospital from Jan 2016 to Mar 2021 was conducted.Results:Of the 40 pHPT patients, 21 (53%) experienced a re-increase of PTH after surgery, but their serum calcium levels were normal and no new parathyroid lesions were found on neck ultrasonography. Univariate analysis showed that there were significant differences in tumor diameter, preoperative PTH level, preoperative serum calcium level, and preoperative alkaline phosphatase level between the postoperative PTH re-increase group and the normal group ( t=-2.042, P=0.045; t=-2.600, P=0.013; t=-2.223, P=0.043; t=-2.162, P=0.037). Regression analysis showed that preoperative PTH level >236 ng/L was an independent risk factor for postoperative PTH re-increase ( OR=5.180, 95% CI: 1.032-25.995). Vitamin D deficiency was common among pHPT patients (88%), and there was a negative correlation between preoperative PTH and 25-hydroxy vitamin D levels. After vitamin D supplementation, the PTH levels of four patients with postoperative PTH re-increase returned to normal. Conclusions:The probability of PTH re-increase in pHPT patients after successful parathyroidectomy was 53%, and most cases occurred in the short term after surgery (within 8 weeks), but it did not indicate disease recurrence. A higher preoperative PTH level was an independent risk factor for postoperative PTH re-increase. Vitamin D deficiency was more common among pHPT patients, and correction of vitamin D deficiency can help restore normal PTH levels after surgery.