Langenbeck's Archives of Surgery

, Volume 391, Issue 6, pp 561–565 | Cite as

Accuracy of intra-operative PTH measurement during subtotal parathyroidectomy for tertiary hyperparathyroidism after renal transplantation

  • Frederic Triponez
  • David Dosseh
  • Marc Hazzan
  • Christian Noel
  • Benoit Soudan
  • Jonathan Lokey
  • Martha Mozzon
  • Charles A. G. Proye
Original Article


Background and aims

Intra-operative parathyroid hormone (IOPTH) results are not known in the setting of tertiary hyperparathyroidism (HPT) after renal transplantation.

Materials and methods

A retrospective analysis of 35 tertiary HPT patients who all underwent subtotal parathyroidectomy and IOPTH monitoring was conducted.


The mean follow-up time was 2.2±1.4 years. Thirty-four patients were cured; one patient (2.8%) had a persistent disease and was cured after reoperation. Median parathyroid hormone (PTH) (median percent decrease from highest) at baseline and at 5, 10, 20, and 30 min were 244, 78 (69%), 63 (75%), 53 (79%), and 49 pg/ml (83%), respectively. Four patients who were cured had a decrease of <50% at 5 min and two of them had a decrease of <50% at 10 min. The patient with persistent disease had a decrease of >50% at 10 min. The sensitivity of the test was 94% at 10 min using the Miami criteria.


This study shows that IOPTH in tertiary hyperparathyroidism has a high sensitivity. However, because of the low risk of persistent hyperparathyroidism when a subtotal parathyroidectomy is performed, its potential impact on the overall success rate is very small. We therefore do not recommend the routine use of IOPTH in tertiary hyperparathyroidism.


Hyperparathyroidism Renal transplantation Intra-operative PTH 


  1. 1.
    Rothmund M, Wagner PK, Schark C (1991) Subtotal parathyroidectomy versus total parathyroidectomy and autotransplantation in secondary hyperparathyroidism: a randomized trial. World J Surg 15(6):745–750PubMedCrossRefGoogle Scholar
  2. 2.
    Kerby JD, Rue LW, Blair H, Hudson S, Sellers MT, Diethelm AG (1998) Operative treatment of tertiary hyperparathyroidism: a single-center experience. Ann Surg 227(6):878–886PubMedCrossRefGoogle Scholar
  3. 3.
    Tominaga Y, Uchida K, Haba T, Katayama A, Sato T, Hibi Y, Numano M, Tanaka Y, Inagaki H, Watanabe I, Hachisuka T, Takagi H (2001) More than 1,000 cases of total parathyroidectomy with forearm autograft for renal hyperparathyroidism. Am J Kidney Dis 38(4 Suppl 1):S168–S171PubMedGoogle Scholar
  4. 4.
    Gasparri G, Camandona M, Abbona GC, Papotti M, Jeantet A, Radice E, Mullineris B, Dei Poli M (2001) Secondary and tertiary hyperparathyroidism: causes of recurrent disease after 446 parathyroidectomies. Ann Surg 233(1):65–69PubMedCrossRefGoogle Scholar
  5. 5.
    Sancho JJ, Sitges-Serra A (1997) Surgical approach to secondary hyperparathyroidism. In: Clark OH, Duh QY (eds) Textbook of endocrine surgery, vol 50. Saunders, San Francisco, pp 403–409Google Scholar
  6. 6.
    Kebebew E, Duh QY, Clark OH (2004) Tertiary hyperparathyroidism: histologic patterns of disease and results of parathyroidectomy. Arch Surg 139(9):974–977PubMedCrossRefGoogle Scholar
  7. 7.
    Triponez F, Dosseh D, Hazzan M, Noel C, Vanhille P, Proye CA (2005) Subtotal parathyroidectomy with thymectomy for autonomous hyperparathyroidism after renal transplantation. Br J Surg 92(10):1282–1287PubMedCrossRefGoogle Scholar
  8. 8.
    Nichol PF, Starling JR, Mack E, Klovning JJ, Becker BN, Chen H (2002) Long-term follow-up of patients with tertiary hyperparathyroidism treated by resection of a single or double adenoma. Ann Surg 235(5):673–678PubMedCrossRefGoogle Scholar
  9. 9.
    Nichol PF, Mack E, Bianco J, Hayman A, Starling JR, Chen H (2003) Radioguided parathyroidectomy in patients with secondary and tertiary hyperparathyroidism. Surgery 134(4):713–717PubMedCrossRefGoogle Scholar
  10. 10.
    Kilgo MS, Pirsch JD, Warner TF, Starling JR (1998) Tertiary hyperparathyroidism after renal transplantation: surgical strategy. Surgery 124(4):677–683PubMedCrossRefGoogle Scholar
  11. 11.
    Cintin C, Karstrup S, Ladefoged SD, Joffe P (1994) Tertiary hyperparathyroidism treated by ultrasonically guided percutaneous fine-needle ethanol injection. Nephron 68(2):217–220PubMedCrossRefGoogle Scholar
  12. 12.
    Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA (1988) Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery 104(6):1121–1127PubMedGoogle Scholar
  13. 13.
    Irvin GL 3rd, Deriso GT 3rd (1994) A new, practical intraoperative parathyroid hormone assay. Am J Surg 168(5):466–468PubMedCrossRefGoogle Scholar
  14. 14.
    Johnson LR, Doherty G, Lairmore T, Moley JF, Brunt LM, Koenig J, Scott MG (2001) Evaluation of the performance and clinical impact of a rapid intraoperative parathyroid hormone assay in conjunction with preoperative imaging and concise parathyroidectomy. Clin Chem 47(5):919–925PubMedGoogle Scholar
  15. 15.
    Udelsman R (2002) Six hundred fifty-six consecutive explorations for primary hyperparathyroidism. Ann Surg 235(5):665–670PubMedCrossRefGoogle Scholar
  16. 16.
    Fahy BN, Bold RJ, Beckett L, Schneider PD (2002) Modern parathyroid surgery: a cost–benefit analysis of localizing strategies. Arch Surg 137(8):917–922PubMedCrossRefGoogle Scholar
  17. 17.
    Westerdahl J, Bergenfelz A (2004) Sestamibi scan-directed parathyroid surgery: potentially high failure rate without measurement of intraoperative parathyroid hormone. World J Surg 28(11):1132–1138PubMedCrossRefGoogle Scholar
  18. 18.
    Lokey J, Pattou F, Mondragon-Sanchez A, Minuto M, Mullineris B, Wambergue F, Foissac-Geroux P, Noel C, de Sagazan HL, VanHille P, Proye CA (2000) Intraoperative decay profile of intact (1–84) parathyroid hormone in surgery for renal hyperparathyroidism—a consecutive series of 80 patients. Surgery 128(6):1029–1034PubMedCrossRefGoogle Scholar
  19. 19.
    Chou FF, Lee CH, Chen JB, Hsu KT, Sheen-Chen SM (2002) Intraoperative parathyroid hormone measurement in patients with secondary hyperparathyroidism. Arch Surg 137(3):341–344PubMedCrossRefGoogle Scholar
  20. 20.
    Seehofer D, Rayes N, Klupp J, Steinmuller T, Ulrich F, Muller C, Schindler R, Frei U, Neuhaus P (2005) Predictive value of intact parathyroid hormone measurement during surgery for renal hyperparathyroidism. Langenbecks Arch Surg 390(3):222–229PubMedCrossRefGoogle Scholar
  21. 21.
    Lepage R, Roy L, Brossard JH, Rousseau L, Dorais C, Lazure C, D’Amour P (1998) A non-(1–84) circulating parathyroid hormone (PTH) fragment interferes significantly with intact PTH commercial assay measurements in uremic samples. Clin Chem 44(4):805–809PubMedGoogle Scholar
  22. 22.
    National Kidney Foundation (2003) K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis 42(4 Suppl 3):1–201Google Scholar
  23. 23.
    Krause MW, Hedinger CE (1985) Pathologic study of parathyroid glands in tertiary hyperparathyroidism. Hum Pathol 16(8):772–784PubMedCrossRefGoogle Scholar
  24. 24.
    Libutti SK, Alexander HR, Bartlett DL, Sampson ML, Ruddel ME, Skarulis M, Marx SJ, Spiegel AM, Simmonds W, Remaley AT (1996) Kinetic analysis of the rapid intraoperative parathyroid hormone assay in patients during operation for hyperparathyroidism. Surgery 126(6):1145–1150Google Scholar
  25. 25.
    Kaczirek K, Riss P, Wunderer G, Prager G, Asari R, Scheuba C, Bieglmayer C, Niederle B (2005) Quick PTH assay cannot predict incomplete parathyroidectomy in patients with renal hyperparathyroidism. Surgery 137(4):431–435PubMedCrossRefGoogle Scholar
  26. 26.
    Boudou P, Ibrahim F, Cormier C, Chabas A, Sarfati E, Souberbielle JC (2005) Third- or second-generation parathyroid hormone assays: a remaining debate in the diagnosis of primary hyperparathyroidism. J Clin Endocrinol Metab 90(12):6370–6372PubMedCrossRefGoogle Scholar
  27. 27.
    Lorenz K, Dralle H (2005) Will intra-operative measurement of parathyroid hormone alter the surgical concept of renal hyperparathyroidism? Langenbecks Arch Surg 390(4):277–279PubMedCrossRefGoogle Scholar
  28. 28.
    Haustein SV, Mack E, Starling JR, Chen H (2005) The role of intraoperative parathyroid hormone testing in patients with tertiary hyperparathyroidism after renal transplantation. Surgery 138(6):1066–1071PubMedCrossRefGoogle Scholar
  29. 29.
    US Renal Data System (USRDS) (2004) Annual data report: atlas of end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MDGoogle Scholar
  30. 30.
    Kaczirek K, Prager G, Riss P, Wunderer G, Asari R, Scheuba C, Bieglmayer C, Niederle B (2006) Novel parathyroid hormone (1–84) assay as basis for parathyroid hormone monitoring in renal hyperparathyroidism. Arch Surg 141(2):129–134PubMedCrossRefGoogle Scholar
  31. 31.
    Yamashita H, Gao P, Cantor T, Noguchi S, Uchino S, Watanabe S, Ogawa T, Kawamoto H, Fukagawa M (2004) Comparison of parathyroid hormone levels from the intact and whole parathyroid hormone assays after parathyroidectomy for primary and secondary hyperparathyroidism. Surgery 135(2):149–156PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Frederic Triponez
    • 1
    • 4
  • David Dosseh
    • 1
  • Marc Hazzan
    • 2
  • Christian Noel
    • 2
  • Benoit Soudan
    • 3
  • Jonathan Lokey
    • 1
  • Martha Mozzon
    • 1
  • Charles A. G. Proye
    • 1
  1. 1.General and Endocrine SurgeryUniversity Hospital of LilleLilleFrance
  2. 2.Nephrology and HemodialysisUniversity Hospital of LilleLilleFrance
  3. 3.Laboratory of Endocrinological BiochemistryUniversity Hospital of LilleLilleFrance
  4. 4.Thoracic and Endocrine SurgeryUniversity Hospital of GenevaGenevaSwitzerland

Personalised recommendations