A Retrospective Study Of Elevated Post-operative Parathormone In Primary Hyperparathyroid Patients

Background:Normocalcemic parathormone elevation(NPE)after surgery in patients with primary hyperparathyroidism(pHPT)was reported to be at risk of recurrence or an indication of incomplete parathyroidectomy,but the cause and clinical significance of this phenomenon have remained unclear yet.Objective:Incidence of NPE after surgery in patients with primary hyperthyroidism and its relationship with postoperative recurrence of hyperthyroidism were summarized through a retrospective study.Methods We retrospectively collected data of patients with pHPT from June 1,2012 to December 31,2015 in Peking Union Medical College Hospital.A statistical analysis was performed to identify the cause of NPE and the relationship between NPE and the recurrent pHPT.Results A total of 309 patients with pHPT were analyzed in this study.Six months after surgery,75 patients exhibited NPE with high preoperative serum levels of alkaline phosphatase,calcium and intact parathyroid hormone(iPTH),postoperative day 1 iPTH,and large parathyroid volume.Fifteen patients remained suffering from NPE 2 years after surgery.Those patients remain with NPE 2 years after surgery were found to had significantly lower serum level of 1,25(OH)2D3 than those with normal serum iPTH.Male patients were more likely to have NPE after surgery(p<0.05).The overall recurrence rate of pHPT after parathyroidectomy was 0.97%(3/309)during the follow-up.Conclusions NPE was a common phenomenon for pHPT patients after successful parathyroidectomy which may be a response of more serious hyperparathyroidism.Patients remain with NPE later postoperative duration may have more serious vitamin D deficiency.The postoperative serum iPTH levels would normalize gradually in most of the patients.NPE did not predict recurrent hyperparathyroidism and incomplete parathyroidectomy.