{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:27:34Z","timestamp":1783643254215,"version":"3.55.0"},"reference-count":28,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T00:00:00Z","timestamp":1568160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T00:00:00Z","timestamp":1568160000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"},{"start":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T00:00:00Z","timestamp":1568160000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/www.springer.com\/tdm"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Recently, normocalcemic (NC) and normohormonal (NH) variants of primary hyperparathyroidism (pHPT) have been described, with distinct biochemical profiles from the typical high serum calcium and parathyroid hormone (PTH) levels. Here, we investigate whether biochemical profile affects cure rate, as well as the kinetics of intraoperative PTH (IOPTH).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This is a single\u2010center, retrospective study of pHPT patients undergoing parathyroidectomy. Patients were grouped based on preoperative calcium and PTH levels into typical, NC (normal calcium, elevated PTH, no evidence of secondary hyperparathyroidism), and NH (elevated calcium, unsuppressed PTH) biochemical profiles. All patients had IOPTH monitoring and\u2009\u22656\u2010month post\u2010op serum studies to confirm surgical cure. Patient variables were analyzed with Kruskal\u2013Wallis test and Chi\u2010square analysis. IOPTH kinetic curves were analyzed using a linear mixed model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>From June 2006 to October 2014, 646 patients met inclusion criteria. Biochemical profile was typical in 460 patients (71%), NC in 101 (16%), and NH in 85 (13%). IOPTH levels were higher at all time points in typical patients, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001. Surgical cure rates were significantly lower for NC patients (90.1%) than for typical (98.5%) or NH patients (97.7%), <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001, although a stricter criteria for cure was used in this group (normal calcium AND normal PTH). In a multivariable linear mixed model, NC patients had a significantly slower rate of IOPTH decline (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001 at 10\u00a0min).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Here, we better characterize the atypical variants of pHPT. Using a stricter definition of cure in the NC variant, these patients have a lower surgical cure rate than typical or NH variants in pHPT. The IOPTH curve is affected by biochemical profile, with both NC and NH patients having lower absolute values and NC patients having a slower decline.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-019-05157-x","type":"journal-article","created":{"date-parts":[[2019,9,11]],"date-time":"2019-09-11T19:02:48Z","timestamp":1568228568000},"page":"488-495","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["Biochemical Profile Affects IOPTH Kinetics and Cure Rate in Primary Hyperparathyroidism"],"prefix":"10.1002","volume":"44","author":[{"given":"Claire E.","family":"Graves","sequence":"first","affiliation":[{"name":"Department of Surgery Columbia University Medical Center 161 Fort Washington Avenue, Suite 829 10032 New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catherine M.","family":"McManus","sequence":"additional","affiliation":[{"name":"Department of Surgery Columbia University Medical Center 161 Fort Washington Avenue, Suite 829 10032 New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John A.","family":"Chabot","sequence":"additional","affiliation":[{"name":"Department of Surgery Columbia University Medical Center 161 Fort Washington Avenue, Suite 829 10032 New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James A.","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Surgery Columbia University Medical Center 161 Fort Washington Avenue, Suite 829 10032 New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer H.","family":"Kuo","sequence":"additional","affiliation":[{"name":"Department of Surgery Columbia University Medical Center 161 Fort Washington Avenue, Suite 829 10032 New York NY 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September 2019","order":1,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Compliance with ethical standards"}},{"value":"The authors declare they have no proprietary or commercial interest in any product mentioned or concept discussed in this article.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflicts of interest"}}]}}