Predictors of persistently elevated parathormone levels after parathyroidectomy : experience from a reference center

Primary hyperparathyroidism (PHPT) is considered the third most common endocrine disorder. Approximately 30% of patients undergoing parathyroidectomy (PTX) have persistently elevated parathormone (PTH) levels. This study aims to determine the prevalence of persistent hyperparathyroidism after PTX and analyze its associated factors. An anonymous review of medical records of patients who underwent PTX at the Hospital de Clínicas de Porto Alegre, a tertiary care center in southern Brazil, from 2010 to 2019, was conducted. Clinical, laboratory, and sociodemographic data were collected from three months before to 18 months after surgery. A total of 261 patients, with a mean age of 63 (46-67) years and body mass index (BMI) of 25.4 (22.0-28.6 kg/m²), were included. Patients with normal PTH levels 18 months after surgery were compared with those who had elevated PTH levels during the same period. Persistently elevated PTH levels occurred in more than half of the patients undergoing PTX. These patients who maintained elevated PTH levels had lower median PTH values and lower minimum PTH levels achieved, as well as higher vitamin D levels. There was no difference between the groups regarding age, BMI, PTH before PTX, calcium levels before or after PTX, and glomerular filtration rate (GFR). A multivariate linear regression model showed a negative association between BMI, GFR, and total calcium after PTX with PTH variation. Patients with reduced GFR had higher PTH levels before PTX, with no significant difference between the groups after the procedure. The observed variation in PTH was significantly higher in patients with reduced GFR. Persistent hyperparathyroidism after PTX is an important issue in osteometabolic health after PTX, particularly in patients with chronic kidney disease (CKD). ; O hiperparatireoidismo primário (HPTP) é considerado o terceiro distúrbio endócrino mais comum. Cerca de 30% dos pacientes submetidos à paratireoidectomia (PTX) apresentam níveis persistentemente elevados de paratormônio (PTH). Este ...