Justified Follow-Up: A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism

Mohammad H. Rajaei, Alex M. Bentz, David F. Schneider, Rebecca S. Sippel, Herbert Chen, Sarah C. Oltmann

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Abstract

Introduction: After parathyroidectomy for sporadic primary hyperparathyroidism (PHPT), overall rates of persistence/recurrence are extremely low. A marker of increased risk for persistence/recurrence is needed. We hypothesized that final intraoperative parathyroid hormone (FioPTH) ≥40 pg/mL is indicative of increased risk for disease persistence/recurrence, and can be used to selectively determine the degree of follow-up.

Method: A retrospective review of PHPT patients undergoing parathyroidectomy with ioPTH monitoring was performed. An ioPTH decline of 50 % was the only criteria for operation termination. Patients were grouped based on FioPTH of <40, 40–59, and >60 pg/mL.

Results: Between 2001 and 2012, 1,371 patients were included. Mean age was 61 ± 0.4 years, and 78°% were female. Overall persistence rate was 1.4°%, with a 2.9°% recurrence rate. Overall, 976 (71°%) patients had FioPTH < 40, 228 (16.6°%) had FioPTH 40–59, and 167 (12.2°%) had FioPTH ≥60. Mean follow-up was 21 ± 0.6 months. Patients with FioPTH <40 were younger, with lower preoperative serum calcium, PTH, and creatinine (all p ≤ 0.001). Patients with FioPTH <40 had the lowest persistence rate (0.2 %) versus patients with FioPTH 40–59 (3.5 %) or FioPTH ≥60 (5.4 %; p < 0.001). Recurrence rate was also lowest in patients with FioPTH <40 (1.3 vs. 5.9 vs. 8.2 %, respectively; p < 0.001). Disease-free status was greatest in patients with FioPTH <40 at 2 years (98.5 vs. 96.8 vs. 90.5 %, respectively) and 5 years (95.7 vs. 72.3 vs. 74.8 %, respectively; p < 0.01).

Conclusions: Patients with FioPTH < 40 pg/mL had lower rates of persistence and recurrence, than patients with FioPTH 40–59, or ≥60. Differences became more apparent after 2 years of follow-up. Patients with FioPTH ≥40 pg/mL warrant close and prolonged follow-up.

Original languageEnglish (US)
Pages (from-to)454-459
Number of pages6
JournalAnnals of Surgical Oncology
Volume22
Issue number2
DOIs
StatePublished - 2014

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Primary Hyperparathyroidism
Parathyroid Hormone
Recurrence
Parathyroidectomy

ASJC Scopus subject areas

  • Surgery
  • Oncology

Cite this

Justified Follow-Up : A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism. / Rajaei, Mohammad H.; Bentz, Alex M.; Schneider, David F.; Sippel, Rebecca S.; Chen, Herbert; Oltmann, Sarah C.

In: Annals of Surgical Oncology, Vol. 22, No. 2, 2014, p. 454-459.

Research output: Contribution to journalArticle

@article{ac031f3d7da24e98bd1a8c13a1fe6638,
title = "Justified Follow-Up: A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism",
abstract = "Introduction: After parathyroidectomy for sporadic primary hyperparathyroidism (PHPT), overall rates of persistence/recurrence are extremely low. A marker of increased risk for persistence/recurrence is needed. We hypothesized that final intraoperative parathyroid hormone (FioPTH) ≥40 pg/mL is indicative of increased risk for disease persistence/recurrence, and can be used to selectively determine the degree of follow-up.Method: A retrospective review of PHPT patients undergoing parathyroidectomy with ioPTH monitoring was performed. An ioPTH decline of 50 {\%} was the only criteria for operation termination. Patients were grouped based on FioPTH of <40, 40–59, and >60 pg/mL.Results: Between 2001 and 2012, 1,371 patients were included. Mean age was 61 ± 0.4 years, and 78°{\%} were female. Overall persistence rate was 1.4°{\%}, with a 2.9°{\%} recurrence rate. Overall, 976 (71°{\%}) patients had FioPTH < 40, 228 (16.6°{\%}) had FioPTH 40–59, and 167 (12.2°{\%}) had FioPTH ≥60. Mean follow-up was 21 ± 0.6 months. Patients with FioPTH <40 were younger, with lower preoperative serum calcium, PTH, and creatinine (all p ≤ 0.001). Patients with FioPTH <40 had the lowest persistence rate (0.2 {\%}) versus patients with FioPTH 40–59 (3.5 {\%}) or FioPTH ≥60 (5.4 {\%}; p < 0.001). Recurrence rate was also lowest in patients with FioPTH <40 (1.3 vs. 5.9 vs. 8.2 {\%}, respectively; p < 0.001). Disease-free status was greatest in patients with FioPTH <40 at 2 years (98.5 vs. 96.8 vs. 90.5 {\%}, respectively) and 5 years (95.7 vs. 72.3 vs. 74.8 {\%}, respectively; p < 0.01).Conclusions: Patients with FioPTH < 40 pg/mL had lower rates of persistence and recurrence, than patients with FioPTH 40–59, or ≥60. Differences became more apparent after 2 years of follow-up. Patients with FioPTH ≥40 pg/mL warrant close and prolonged follow-up.",
author = "Rajaei, {Mohammad H.} and Bentz, {Alex M.} and Schneider, {David F.} and Sippel, {Rebecca S.} and Herbert Chen and Oltmann, {Sarah C.}",
year = "2014",
doi = "10.1245/s10434-014-4006-x",
language = "English (US)",
volume = "22",
pages = "454--459",
journal = "Annals of Surgical Oncology",
issn = "1068-9265",
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number = "2",

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TY - JOUR

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T2 - A Final Intraoperative Parathyroid Hormone (ioPTH) Over 40 pg/mL is Associated with an Increased Risk of Persistence and Recurrence in Primary Hyperparathyroidism

AU - Rajaei, Mohammad H.

AU - Bentz, Alex M.

AU - Schneider, David F.

AU - Sippel, Rebecca S.

AU - Chen, Herbert

AU - Oltmann, Sarah C.

PY - 2014

Y1 - 2014

N2 - Introduction: After parathyroidectomy for sporadic primary hyperparathyroidism (PHPT), overall rates of persistence/recurrence are extremely low. A marker of increased risk for persistence/recurrence is needed. We hypothesized that final intraoperative parathyroid hormone (FioPTH) ≥40 pg/mL is indicative of increased risk for disease persistence/recurrence, and can be used to selectively determine the degree of follow-up.Method: A retrospective review of PHPT patients undergoing parathyroidectomy with ioPTH monitoring was performed. An ioPTH decline of 50 % was the only criteria for operation termination. Patients were grouped based on FioPTH of <40, 40–59, and >60 pg/mL.Results: Between 2001 and 2012, 1,371 patients were included. Mean age was 61 ± 0.4 years, and 78°% were female. Overall persistence rate was 1.4°%, with a 2.9°% recurrence rate. Overall, 976 (71°%) patients had FioPTH < 40, 228 (16.6°%) had FioPTH 40–59, and 167 (12.2°%) had FioPTH ≥60. Mean follow-up was 21 ± 0.6 months. Patients with FioPTH <40 were younger, with lower preoperative serum calcium, PTH, and creatinine (all p ≤ 0.001). Patients with FioPTH <40 had the lowest persistence rate (0.2 %) versus patients with FioPTH 40–59 (3.5 %) or FioPTH ≥60 (5.4 %; p < 0.001). Recurrence rate was also lowest in patients with FioPTH <40 (1.3 vs. 5.9 vs. 8.2 %, respectively; p < 0.001). Disease-free status was greatest in patients with FioPTH <40 at 2 years (98.5 vs. 96.8 vs. 90.5 %, respectively) and 5 years (95.7 vs. 72.3 vs. 74.8 %, respectively; p < 0.01).Conclusions: Patients with FioPTH < 40 pg/mL had lower rates of persistence and recurrence, than patients with FioPTH 40–59, or ≥60. Differences became more apparent after 2 years of follow-up. Patients with FioPTH ≥40 pg/mL warrant close and prolonged follow-up.

AB - Introduction: After parathyroidectomy for sporadic primary hyperparathyroidism (PHPT), overall rates of persistence/recurrence are extremely low. A marker of increased risk for persistence/recurrence is needed. We hypothesized that final intraoperative parathyroid hormone (FioPTH) ≥40 pg/mL is indicative of increased risk for disease persistence/recurrence, and can be used to selectively determine the degree of follow-up.Method: A retrospective review of PHPT patients undergoing parathyroidectomy with ioPTH monitoring was performed. An ioPTH decline of 50 % was the only criteria for operation termination. Patients were grouped based on FioPTH of <40, 40–59, and >60 pg/mL.Results: Between 2001 and 2012, 1,371 patients were included. Mean age was 61 ± 0.4 years, and 78°% were female. Overall persistence rate was 1.4°%, with a 2.9°% recurrence rate. Overall, 976 (71°%) patients had FioPTH < 40, 228 (16.6°%) had FioPTH 40–59, and 167 (12.2°%) had FioPTH ≥60. Mean follow-up was 21 ± 0.6 months. Patients with FioPTH <40 were younger, with lower preoperative serum calcium, PTH, and creatinine (all p ≤ 0.001). Patients with FioPTH <40 had the lowest persistence rate (0.2 %) versus patients with FioPTH 40–59 (3.5 %) or FioPTH ≥60 (5.4 %; p < 0.001). Recurrence rate was also lowest in patients with FioPTH <40 (1.3 vs. 5.9 vs. 8.2 %, respectively; p < 0.001). Disease-free status was greatest in patients with FioPTH <40 at 2 years (98.5 vs. 96.8 vs. 90.5 %, respectively) and 5 years (95.7 vs. 72.3 vs. 74.8 %, respectively; p < 0.01).Conclusions: Patients with FioPTH < 40 pg/mL had lower rates of persistence and recurrence, than patients with FioPTH 40–59, or ≥60. Differences became more apparent after 2 years of follow-up. Patients with FioPTH ≥40 pg/mL warrant close and prolonged follow-up.

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U2 - 10.1245/s10434-014-4006-x

DO - 10.1245/s10434-014-4006-x

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AN - SCOPUS:84921061871

VL - 22

SP - 454

EP - 459

JO - Annals of Surgical Oncology

JF - Annals of Surgical Oncology

SN - 1068-9265

IS - 2

ER -