O. A. Lavryk1, A. E. Siperstein1 1Cleveland Clinic,Endocrine Surgery,Cleveland, OH, USA
Introduction: At 12 month after parathyroid surgery we expect cured patients to have same biochemical characteristics as healthy individuals. The aim of the current study was to compare patients’ characteristics at 12 months after neck exploration for primary sporadic hyperparathyroidism (1?HP) with the healthy controls.
Methods: 484 patients were analyzed, who underwent parathyroid neck surgery for 1?HP from 2000-2014. 74 healthy subjects were enrolled as a control group. Calcium (Ca) and parathyroid hormone (PTH) were collected before and after surgery. To assess the biochemical profile of patients on the graphical plots of Ca vs PTH were used to compare the 95 % confidence area of healthy patients to those after parathyroid surgery. Patients were supplemented with Ca and vitamin D postoperatively.
Results:Preoperatively patients with 1?HP had a Ca of 10.9 ± 0.5 (mean ± standard deviation (SD) mg/dL and PTH 124.4 ± 68.5 pg/dL vs controls of 9.2 ± 0.3 mg/dL and 34.4±13.4 pg/dL, respectively. On plots of Ca vs PTH, all 1?HP patients preoperatively had values outside the normal zone. Postoperatively at 12 months, 335 (69%) of patients returned within the normal zone. 13 (2.7%) had absolute elevation of Ca and PTH, showing continued disease. 2 (0.4%) patients had hypoparathyroidism, both after undergoing subtotal parathyroidectomy. 149 (27.9%) had Ca and PTH values outside the normal zone, but not falling into the above categories. There was no marked difference in patients with simple adenoma vs multiple gland disease.
Conclusion:At 12 moths follow up postoperatively, many patients with 1?HP fail to have their Ca and PTH fall within the 95% confidence zone for normal individuals. Thus, 5% are attributed to the confidence interval chosen. Although some may reflect the persistent disease, many patients have unclear an pattern,despite Ca and vitamin D supplementation. Longer follow-up might be needed for patients after parathyroid surgery to reestablish stabilization of biochemical profiles.