EVALUATION OF SURGICAL-TREATMENT OF RENAL HYPERPARATHYROIDISM BY MEASURING INTACT PARATHORMONE BLOOD-LEVELS ON FIRST POSTOPERATIVE DAY

Intact parathormone (inPTH) has a short half-life. Its blood level on the first day after total parathyroidectomy and subcutaneous parathyro id implantation (PTX + G) should therefore allow an early diagnosis of missed residual parathyroid tissue, We tested this hypothesis in 72 u remic patients who were followed for 6 to 110 months after operation. Nine were reoperated for recurrence of the disease. Graft removal was successful in four patients who had post-PTX inPTH levels of 16 pg/ml or lower. In five patients, an overlooked parathyroid gland had to be resected, All of them had elevated post-PTX inPTH blood levels ranging from 72 to 791 pg/ml (upper normal limit 55 pg/ml), Three of these pa tients had presented with hypocalcemia after PTX. We conclude that the inPTH blood concentration on the first day after PTX allows more prec ise evaluation of the efficacy of the surgical procedure han the posto perative evolution of blood calcium levels. It is also useful for loca lizing the source of excessive PTH secretion (graft or overlooked glan d) when the disease recurs.