{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,1]],"date-time":"2025-11-01T01:21:39Z","timestamp":1761960099264,"version":"build-2065373602"},"reference-count":32,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2010,4,13]],"date-time":"2010-04-13T00:00:00Z","timestamp":1271116800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2010,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Elevation of parathyroid hormone (PTH) levels is commonly seen in patients with primary hyperparathyroidism (PHPT) who have undergone parathyroidectomy. This study evaluates differences in 2\u2010week postoperative PTH levels in patients having focused\u2010approach surgery versus four\u2010gland exploration.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Over 6 years, patients at Rhode Island Hospital (RIH) and the Cleveland Clinic (CCF) who had PHPT and underwent localization studies suggestive of single adenoma were analyzed. At RIH patients underwent focused\u2010approach surgery, and at CCF routine four\u2010gland exploration was performed. Postoperative calcium supplementation was routine at RIH and selective at CCF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were 308 patients at RIH and 370 at CCF. They were similar in age (59.2 \u00b1 13.0 years at RIH and 60.4 \u00b1 12.9 years at CCF), and sex (76.9 and 80.0% female at RIH and CCF, respectively). The mean preoperative serum calcium measured 10.9 \u00b1 0.7\u00a0mg\/dl at RIH and 11.1 \u00b1 0.7\u00a0mg\/dl at CCF (<jats:italic>P<\/jats:italic> &lt; 0.001). Preoperative PTH values were similar, measuring 143.8 \u00b1 104.8 pg\/ml in the focused\u2010approach group (RIH) and 157.6 \u00b1 150.3 pg\/ml in the four\u2010gland exploration group (CCF). Preoperative 25\u2010hydroxyvitamin D (vitamin D\u201025) levels were 24.1 \u00b1 12.0\u00a0ng\/ml at RIH and 27.4 \u00b1 10.6\u00a0ng\/ml at CCF; and the prevalence of vitamin D\u201025 deficiency (level &lt;20\u00a0ng\/ml) was 43.9% at RIH and 27% at CCF (<jats:italic>P<\/jats:italic> = 0.017). The proportion of patients whose intraoperative PTH value dropped by \u226550% prior to completion of surgery was 95.0% at RIH and 95.5% at CCF. The total gland weight resected per patient was 942\u00a0mg at RIH versus 1,394\u00a0mg at CCF (<jats:italic>P<\/jats:italic> = 0.003). The 2\u2010week postoperative serum PTH was &gt;65 pg\/ml in 18.8% at RIH and in 38.7% at CCF (<jats:italic>P<\/jats:italic> &lt; 0.001). The 2\u2010week postoperative serum calcium values dropped to 9.2 \u00b1 0.6\u00a0mg\/dl at RIH and to 9.5 \u00b1 0.8\u00a0mg\/dl at CCF (<jats:italic>P<\/jats:italic> &lt; 0.001). The incidence of multigland disease was 5.8% at RIH and 21.9% at CCF (<jats:italic>P<\/jats:italic> \u2264 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Among patients with PHPT who underwent a localizing study indicating unilateral disease, a significant proportion had eucalcemic PTH elevation 2 weeks after parathyroidectomy. The elevation was more frequent in the four\u2010gland exploration group and correlated most strongly with greater adenoma mass.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-010-0557-6","type":"journal-article","created":{"date-parts":[[2010,4,12]],"date-time":"2010-04-12T16:44:59Z","timestamp":1271090699000},"page":"1318-1324","source":"Crossref","is-referenced-by-count":15,"title":["Normalization of 2\u2010Week Postoperative Parathyroid Hormone Values in Patients with Primary Hyperparathyroidism: Four\u2010Gland Exploration Compared to Focused\u2010Approach Surgery"],"prefix":"10.1002","volume":"34","author":[{"given":"Peter J.","family":"Mazzaglia","sequence":"first","affiliation":[{"name":"Warren Alpert School of Medicine Brown University, Rhode Island Hospital 154 Waterman Street 02906 Providence RI USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mira","family":"Milas","sequence":"additional","affiliation":[{"name":"Endocrine Surgery Department\/A80, 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