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Factors that influence parathyroid hormone half-life: determining if new intraoperative criteria are needed. JAMA Surg 2013 Jul;148(7):602-6



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2-s2.0-84880580476   31 Citations


IMPORTANCE: Minimally invasive parathyroidectomy using intraoperative parathyroid hormone monitoring remains the standard approach to the majority of patients with primary hyperparathyroidism. This study demonstrates that individual patient characteristics do not affect existing criteria for intraoperative parathyroid hormone monitoring.

OBJECTIVE: To identify patient characteristics, such as age, sex, race, body mass index (BMI), and renal function, that may affect existing criteria for intraoperative parathyroid hormone (IOPTH) levels during minimally invasive parathyroidectomy.

DESIGN: Retrospective review of a prospectively collected parathyroid database populated from August 2005 to April 2011.

SETTING: Academic medical center.

PARTICIPANTS: Three hundred six patients with sporadic primary hyperparathyroidism who underwent initial parathyroidectomy between August 2005 and April 2011.

INTERVENTIONS: All patients underwent minimally invasive parathyroidectomy with complete IOPTH information.

MAIN OUTCOME AND MEASURES: Individual IOPTH kinetic profiles were fitted with an exponential decay curve and individual IOPTH half-lives were determined. Univariate and multivariate analyses were performed to determine the association between patient demographics or laboratory data and IOPTH half-life.

RESULTS: Mean age of the cohort was 60 years, 78.4% were female, 90.2% were white, and median BMI was 28.3. Overall, median IOPTH half-life was 3 minutes, 9 seconds. On univariate analysis, there was no association between IOPTH half-life and patient age, renal function, or preoperative serum calcium or parathyroid hormone levels. Age, BMI, and an age × BMI interaction were included in the final multivariate median regression analysis; race, sex, and glomerular filtration rate were not predictors of IOPTH half-life. The IOPTH half-life increased with increasing BMI, an effect that diminished with increasing age and was negligible after age 55 years (P = .001).

CONCLUSIONS AND RELEVANCE: Body mass index, especially in younger patients, may have a role in the IOPTH half-life of patients undergoing parathyroidectomy. However, the differences in half-life are relatively small and the clinical implications are likely not significant. Current IOPTH criteria can continue to be applied to all patients undergoing parathyroidectomy for sporadic primary hyperparathyroidism.

Author List

Leiker AJ, Yen TW, Eastwood DC, Doffek KM, Szabo A, Evans DB, Wang TS


Douglas B. Evans MD Chair, Professor in the Surgery department at Medical College of Wisconsin
Aniko Szabo PhD Professor in the Institute for Health and Equity department at Medical College of Wisconsin
Tracy S. Wang MD, MPH Professor in the Surgery department at Medical College of Wisconsin
Tina W F Yen MD, MS Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Hyperparathyroidism, Primary
Middle Aged
Minimally Invasive Surgical Procedures
Monitoring, Intraoperative
Parathyroid Hormone
Retrospective Studies
jenkins-FCD Prod-482 91ad8a360b6da540234915ea01ff80e38bfdb40a