The success of sporadic primary hyperparathyroidism (SPHPT) treatment is providing normocalcemia independent from parathormone (PTH) levels after parathyroidectomy. However, the PTH levels of 7–40% cases remain elevated. We aimed to determine the timing of the postoperative elevation of PTH, and the relation with type of the operation, preoperative vitamin D levels, and season of the operation. Medical records of 119 SPHPT patients were reviewed retrospectively. For the purpose of the study, 99 patients were appropriate. The study is performed in Izmir, Turkey, and surrounding regions. The patients are grouped as operated on summer-spring and winter-autumn based on the sun exposure. On preoperative, postoperative 1st day, 1st week, 3rd month, 6th month, 12th month PTH levels, calcium, and vitamin D before and a year after the operation were noted. A total of 99 patients with a mean age of 57.88 were included. Low PTH levels in the first day of the operation had significant relation with high PTH levels in the first 6 months (p < 0.05). On the third month, eucalcemic parathyroid hormone elevation (ePTH) reached the top level and declined to 53% and 26% in 6th and 12th month, respectively. There is no significant difference between preoperative vitamin D levels, operation type, and the season of operation time; however, ePTH was more common in patients operated in autumn-winter. Our results showed that ePTH development was unrelated with vitamin D levels, operation type, and operation season. ePTH should not be accepted as an indicator of recurrence on early follow-up of patients having appropriate medical supplementation.
This is a preview of subscription content, log in to check access.
Compliance with Ethical Standards
We obtained informed consent from patients and certification from the Izmir Katip Celebi University Ataturk Training and Research Hospital Ethical Committee about the relevance of the study.
Conflicts of Interest
The authors declare that they have no conflict of interest.
Duh QY, Arnaud CD, Levin KE, Clark OH (1986) Parathyroid hormone: before and after parathyroidectomy. Surgery 100:1021–1304Google Scholar
Bergenfelz A, Valdemarsson S, Tibblin S (1996) Persistent elevated serum levels of intact parathyroid hormone after operation for sporadic parathyroid adenoma: evidence of detrimental effects of severe parathyroid disease. Surgery 119:624–633CrossRefGoogle Scholar
Irvin GL, Molinari AS, Carneiro DM, Rivabem F, Ruel MM, Boggs JE (1999) Parathyroidectomy: new criteria for evaluating outcome. Am Surg 65:1186–1188 discussion 1188-1189Google Scholar
Caron NR, Sturgeon C, Clark OH (2004) Persistent and recurrent hyperparathyroidism. Curr Treat Options in Oncol 5:335–345CrossRefGoogle Scholar
Mittendorf EA, McHenry CR (2002) Persistent parathyroid hormone elevation following curative parathyroidectomy for primary hyperparathyroidism. Arch Otolaryngol Head Neck Surg 28:275–279CrossRefGoogle Scholar
Silverberg SJ, Shane E, Demptster DW, Bilezikian JP (1999) The effects of vitamin D insufficiency in patients with primary hyperparathyroidism. Am J Med 107:561–567CrossRefGoogle Scholar
Westerdahl J, Lindblom P, Bergenfelz A (2002) Measurement of intraoperative parathyroid hormone predicts long-term operative success. Arch Surg 137:186–190CrossRefGoogle Scholar
Irvin GL, Carneiro DM, Solorzano CC (2004) Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg 239(5):704–711CrossRefGoogle Scholar
Sackett WR, Barraclough B, Reeve TS, Delbridge LW (2002) World trends in the surgical treatment of primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Arch Surg 137:1055–1059CrossRefGoogle Scholar
Udelsman R (2002) Six hundred fifty six consecutive explorations for primary hyperparathyroidism. Ann Surg 235:665–672CrossRefGoogle Scholar
Grant CS, Thompson G, Farley D, van Heerden J (2005) Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg 140:472–478CrossRefGoogle Scholar
Chen H, Pruhs Z, Starling JR, Mack E (2005) Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery 138:583–590CrossRefGoogle Scholar
Hekimsoy Z, Dinç G, Kafesçiler S, Onur E, Güvenç Y, Pala T, Güçlü F, Özmen B (2010) Vitamin D status among adults in the Aegean region of Turkey. BMC Public Health 10(1):782CrossRefGoogle Scholar
Denizot A, Pucini M, Chagnaud C, Botti G, Henry JF (2001) Normocalcemia with elevated parathyroid hormone levels after surgical treatment of primary hyperparathyroidism. Am J Surg 182:15–19CrossRefGoogle Scholar
Malabaran A, Veronikis IE, Holick MF (1998) Redefining vitamin D deficiency. Lancet 351:805–806CrossRefGoogle Scholar
Glerup H, Mikkelsen K, Poulsen L, Hass E, Overbeck S, Thomsen J, Charles P, Eriksen EF (2000) Commonly recommended daily intake of vitamin D is not sufficient if sunlight exposure is limited. J Intern Med 247:260–268CrossRefGoogle Scholar
Lips P (2001) Vitamin D deficiency and secondary hyperparathyroidism in the elderly: consequences for bone loss and fractures and therapeutic implications. Endocr Rev 22:477–501CrossRefGoogle Scholar