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Year : 2020  |  Volume : 24  |  Issue : 4  |  Page : 366-372

Persistent elevation of parathormone levels after surgery for primary hyperparathyroidism

1 Endocrinology, DIABETES and ENDOCARE Clinic, Berhampur, Odisha, India
2 Anesthesia, Corniche Hospital, Abu Dhabi, UAE
3 Pharmaceutics, Roland Institute of Pharmaceutical Sciences, Berhampur, Odisha, India
4 Endocrine Surgery, Endocare Hospital, Vijayawada, Andhra Pradesh, India
5 Endocrinology, IMS and SUM Hospital, Bhubaneswar, Odisha, India
6 Endocrinology, Hi Tech Medical College, Bhubaneswar, Odisha, India
7 Endocrinology, Endocare Hospital, Vijayawada, Andhra Pradesh, India
8 Endocrinology, Endolife Hospital, Guntur, Andhra Pradesh, India
9 Endocrinology, Military Hospital, Secunderabad, Telangana, India
10 Endocrinology, CARE Hospital, Nampally, Hyderabad, Telangana, India

Correspondence Address:
Sunil K Kota
Consultant Endocrinologist, DIABETES and ENDOCARE Clinic, Berhampur - 760 001, Odisha
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijem.IJEM_212_20

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Background: Persistent elevation of serum parathyroid hormone (PTH) despite normocalcemia have been documented in 8- 40% of patients after parathyroidectomy. We hereby report our experience from different centers across India to determine clinical significance of postoperatively elevated PTH levels and review relevant literature. Methods: We conducted a retrospective case series study and reviewed all the patients who underwent surgery for primary hyperparathyroidism (PHPT) from April 2010 to January 2020. Results: Total of 201 patients was diagnosed as PHPT. Out of available follow-up data of 180 patients, a total of 54 patients (30%) had persistently elevated PTH (PePTH) at 1 month. Patients with PePTH were older with higher preoperative serum calcium, iPTH, alkaline phosphatase and lower serum phosphate and 25-hydroxy vitamin D3 levels. Creatinine clearance was found to be significantly lower in patients with PePTH. Multiple linear regression analysis revealed that preoperative 25-OH D3 concentration, creatinine clearance and iPTH are the factors influencing persistent elevation of PTH levels. Significantly lower serum calcium and higher alkaline phosphatase levels were observed in PePTH patients with preoperative 25-OH D3 levels <20 ng/mL. Thirty patients at 6 months, 24 patients at 1 year, 18 patients at 2 years and 9 patients at 3 years had eucalcemic PTH elevation. Nine out of 126 (7%) patients with normal initial postoperative calcium and iPTH levels developed PePTH, with none culminating into recurrent hyperparathyroidism. Conclusion: Though the pathogenesis of such a phenomenon still remains to be elucidated, a multifactorial mechanism appears to play a role.

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