{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:52:08Z","timestamp":1778806328516,"version":"3.51.4"},"reference-count":11,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T00:00:00Z","timestamp":1624838400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100016991","name":"Universidad de Guadalajara","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100016991","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Surg."],"abstract":"<jats:p><jats:bold>Introduction:<\/jats:bold> Secondary hyperparathyroidism (SHPT) is a multisystemic syndrome that affects calcium and bone homeostasis in patients with chronic kidney disease (CKD). Despite medical treatment, 1\u20132% of patients require parathyroidectomy annually. The use of an intraoperative parathormone protocol (IOPTH) to predict cure is still in debate, due to the lack of standardized protocols, the use of different assays, and uneven PTH clearance. This study aimed to determine the diagnostic accuracy of an IOPTH in patients with SHPT for predicting successful surgery after parathyroidectomy.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> About 30 patients were enrolled. A prospective observational study (cohort) was performed in patients who were submitted to parathyroidectomy by an endocrine surgeon for SHPT. All were submitted to a bilateral neck exploration with a subtotal parathyroidectomy. Three IOPTH determinations were withdrawn: at anesthetic induction (PTH<jats:sub>0<\/jats:sub>), 15 min (PTH<jats:sub>15<\/jats:sub>), and 30 min (PTH<jats:sub>30<\/jats:sub>) after completion of gland resection. Another sample was taken 24 h after the procedure (PTH<jats:sub>24<\/jats:sub>), values &amp;lt;150 pg\/mL defined a successful surgery, and patients were assigned to the success or failure group. IOPTH drop was analyzed to predict successful surgery with drops of 70 and 90% at 15 and 30 min, respectively.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> A total of 26 patients were included, 19 patients were in the successful group. IOPTH showed a significant difference between groups in their absolute PTH<jats:sub>15<\/jats:sub> and PTH<jats:sub>30<\/jats:sub> values. A significant difference was also found in their PTH drop at 30 min (81 vs. 91%, <jats:italic>p<\/jats:italic> = 0.08). For predicting a successful surgery, having a PTH drop &amp;gt;90% at 30 min was the most significant factor [Odds Ratio (OR) 3.0 (1.5\u20134) IC 95%].<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> This study points toward a stricter and staggered IOPTH protocol to predict a successful surgery. Our results suggest taking a PTH<jats:sub>15<\/jats:sub> expecting a PTH drop of &amp;gt;90%. If this is not achieved, reexploration and a PTH<jats:sub>30<\/jats:sub> sample are suggested to accurately predict success.<\/jats:p>","DOI":"10.3389\/fsurg.2021.696469","type":"journal-article","created":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T05:08:51Z","timestamp":1624856931000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":8,"title":["The Usefulness of Intraoperative PTH as a Predictor for Successful Parathyroidectomy in Secondary Hyperparathyroidism"],"prefix":"10.3389","volume":"8","author":[{"given":"Karla Ver\u00f3nica","family":"Ch\u00e1vez","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Horacio","family":"M\u00e1rquez-Gonz\u00e1lez","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mariana","family":"Chavez-Tostado","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2021,6,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1227","DOI":"10.1016\/j.suc.2009.06.011","article-title":"Secondary and tertiary hyperparathyroidism, state of the art surgical management","volume":"89","author":"Pitt","year":"2009","journal-title":"Surg Clin North Am."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.kisu.2017.04.001","article-title":"KDIGO 2017 clinical practice guideline update for the diagnosis, evaluation, prevention, and treatment of chronic kidney disease\u2013mineral and bone disorder (CKD-MBD)","volume":"7","author":"Garaberd","year":"2017","journal-title":"Kidney Int Suppl."},{"key":"B3","doi-asserted-by":"publisher","first-page":"1179","DOI":"10.1111\/j.1523-1755.2005.00185.x","article-title":"Predictors and consequences of altered mineral metabolism: the dialysis outcomes and practice patterns study","volume":"67","author":"Young","year":"2005","journal-title":"Kidney Int."},{"key":"B4","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1007\/s00423-015-1344-5","article-title":"Surgical management of secondary hyperparathyroidism in chronic kidney disease\u2014a consensus report of the European Society of Endocrine Surgeons","volume":"400","author":"Lorenz","year":"2015","journal-title":"Langenbecks Arch Surg."},{"key":"B5","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1016\/j.surg.2003.06.001","article-title":"Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate?","volume":"134","author":"Carneiro","year":"2003","journal-title":"Surgery."},{"key":"B6","doi-asserted-by":"publisher","first-page":"885","DOI":"10.1172\/JCI110106","article-title":"Peripheral metabolism of intact parathyroid hormone. Role of liver kidney the effect of chronic renal failure","volume":"67","author":"Hruska","year":"1981","journal-title":"J Clin Invest."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1097\/MD.0000000000001213","article-title":"A retrospective study of the impact of intraoperative intact parathyroid hormone monitoring during total parathyroidectomy for secondary hyperparathyroidism","volume":"94","author":"Hiramitsu","year":"2015","journal-title":"Med"},{"key":"B8","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1007\/s00423-005-0541-z","article-title":"Predictive value of intact parathyroid hormone measurement during surgery for renal hyperparathyroidism","volume":"390","author":"Seehofer","year":"2005","journal-title":"Langenbecks Arch Surg."},{"key":"B9","doi-asserted-by":"publisher","first-page":"538","DOI":"10.1016\/j.clinbiochem.2016.01.012","article-title":"Intra-operative parathyroid hormone monitoring through central laboratory is accurate in renal secondary hyperparathyroidism","volume":"49","author":"Vulpio","year":"2016","journal-title":"Clin Biochem."},{"key":"B10","doi-asserted-by":"publisher","first-page":"1029","DOI":"10.1067\/msy.2000.110431","article-title":"Intraoperative decay profile of intact (1-84) parathyroid hormone in surgery for renal hyperparathyroidism\u2013a consecutive series of 80 patients","volume":"128","author":"Lokey","year":"2000","journal-title":"Surgery."},{"key":"B11","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1007\/s00423-004-0535-2","article-title":"A randomised study on a new cost-effective algorithm of quick intraoperative intact parathyroid hormone assay in secondary hyperparathyroidism","volume":"390","author":"Barczy\u0144ski","year":"2005","journal-title":"Langenbecks Arch Surg."}],"container-title":["Frontiers in Surgery"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.696469\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,28]],"date-time":"2021-06-28T05:08:53Z","timestamp":1624856933000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fsurg.2021.696469\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,6,28]]},"references-count":11,"alternative-id":["10.3389\/fsurg.2021.696469"],"URL":"https:\/\/doi.org\/10.3389\/fsurg.2021.696469","relation":{},"ISSN":["2296-875X"],"issn-type":[{"value":"2296-875X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,6,28]]},"article-number":"696469"}}