{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T16:57:38Z","timestamp":1790787458328,"version":"4.1.0"},"reference-count":24,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: Postoperative early hypocalcemia (PEH) is a key postoperative issue after parathyroidectomy in primary hyperparathyroidism. It often leads to long-lasting hypocalcemia, requiring more calcium and active vitamin D supplements. This study aimed to determine whether the extent of intraoperative parathyroid hormone (PTH) decline, measured 15 min after parathyroid tumor excision, could serve as a reliable intraoperative rule-out marker for PEH. Methods: We conducted a retrospective review of 88 adult patients who underwent surgical intervention for a solitary parathyroid tumor at a single institution. Postoperative early hypocalcemia (PEH) was defined as a total serum calcium level &lt;8.5 mg\/dL within the postoperative 6th hour or on postoperative day 1, requiring clinical calcium supplementation (oral and\/or intravenous), with active vitamin D when appropriate. The percentage decrease in PTH at 15 min post-excision was calculated using morning-of-surgery preoperative PTH values alongside the 15-min post-excision levels. Additional variables assessed included preoperative alkaline phosphatase (ALP), parathyroid tumor weight, and serum concentrations of calcium, phosphate, magnesium, and 25-hydroxyvitamin D. Predictive factors were identified by logistic regression, and the diagnostic accuracy of the 15-min PTH decline was evaluated using receiver operating characteristic (ROC) curve analysis, optimizing cutoff selection with Youden\u2019s index. Odds ratios were standardized per 10-unit increments for ALP and parathyroid tumor weight for interpretability. Results: Of the studied cohort, 10 patients (11.4%) developed PEH. The intraoperative 15-min PTH decline was notably greater in those who developed PEH compared to those who did not (81.2 \u00b1 4.4% vs. 69.9 \u00b1 8.3%; p &lt; 0.001). Univariate logistic regression showed a significant association between the 15-min PTH decline and PEH (OR 1.22 per 1% increment; 95% CI 1.08\u20131.38). That said, when we added ALP and parathyroid tumor weight to the multivariate models, PTH decline no longer predicted independently. In contrast, ALP (OR 3.11 per 10 U\/L; 95% CI 1.34\u20137.93; p = 0.011) and parathyroid tumor weight (OR 1.22 per 10 mg; 95% CI 1.10\u20131.48; p = 0.004) stayed significant. Thus, the incremental prognostic contribution of the 15-min PTH decline beyond ALP and parathyroid tumor weight appears limited. The ROC curve for the 15-min PTH decline produced an AUC of 0.883, with an optimal cutoff of 75% providing 100% sensitivity and 74.4% specificity. No patients with a PTH decline below 75% developed PEH. Conclusions: Preoperative ALP and parathyroid tumor weight showed the strongest independent associations with PEH following parathyroid tumor surgery. An intraoperative PTH decline of less than 75% at 15 min may serve as a practical rule-out tool for PEH, although further validation in larger patient populations is warranted.<\/jats:p>","DOI":"10.3390\/diagnostics16040636","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:39:10Z","timestamp":1771846750000},"page":"636","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association of Intraoperative Parathyroid Hormone Decline with Early Postoperative Hypocalcemia: A Single-Center Retrospective Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1979-2426","authenticated-orcid":false,"given":"Suat","family":"Evirgen","sequence":"first","affiliation":[{"name":"Department of General Surgery, Serefeddin Sabuncuo\u011flu Training and Research Hospital, Amasya University, 05200 Amasya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elif","family":"Menekse","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Serefeddin Sabuncuo\u011flu Training and Research Hospital, Amasya University, 05200 Amasya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0657-3841","authenticated-orcid":false,"given":"Ecem","family":"Avci","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Serefeddin Sabuncuo\u011flu Training and Research Hospital, Amasya University, 05200 Amasya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Burak Yasin","family":"Avci","sequence":"additional","affiliation":[{"name":"Department of Medical Biochemistry, Serefeddin Sabuncuo\u011flu Training and Research Hospital, Amasya University, 05200 Amasya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"\u00c7i\u011fdem Tura","family":"Bahad\u0131r","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, TOBB ETU Hospital, 06510 Ankara, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cafer","family":"Polat","sequence":"additional","affiliation":[{"name":"Department of General Surgery, Serefeddin Sabuncuo\u011flu Training and Research Hospital, Amasya University, 05200 Amasya, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2293","DOI":"10.1002\/jbmr.4677","article-title":"Evaluation and Management of Primary Hyperparathyroidism: Summary Statement and Guidelines from the Fifth International Workshop","volume":"37","author":"Bilezikian","year":"2022","journal-title":"J. Bone Miner. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"zrac118","DOI":"10.1093\/bjsopen\/zrac118","article-title":"The value of intraoperative parathyroid hormone monitoring in patients with primary hyperparathyroidism and varying baseline parathyroid hormone levels","volume":"6","author":"Hargitai","year":"2022","journal-title":"BJS Open"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"3878","DOI":"10.1038\/s41598-022-07380-4","article-title":"The Rome criterion: Improving intraoperative parathyroid hormone monitoring in primary hyperparathyroidism","volume":"12","author":"Graceffa","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Carsote, M., and Nistor, C.E. (2023). Forestalling Hungry Bone Syndrome after Parathyroidectomy in Patients with Primary and Renal Hyperparathyroidism. Diagnostics, 13.","DOI":"10.3390\/diagnostics13111953"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.afos.2022.03.004","article-title":"Hungry bone syndrome following parathyroidectomy for primary hyperparathyroidism in a developed country in the Asia Pacific: A cohort study","volume":"8","author":"Chandran","year":"2022","journal-title":"Osteoporos. Sarcopenia"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"310","DOI":"10.1016\/j.endinu.2019.05.011","article-title":"Risk factors and evolution of calcium and parathyroid hormone levels in hungry bone syndrome after parthyroidectomy for primary hyperparathyroidism. Factores de riesgo y evoluci\u00f3n del calcio y hormona paratiroidea en el s\u00edndrome de hueso hambriento tras paratiroidectom\u00eda por hiperparatiroidismo primario","volume":"67","year":"2020","journal-title":"Endocrinol. Diabetes Y Nutr."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"329","DOI":"10.1177\/1457496920962601","article-title":"Role of vitamin D supplements in prevention of hungry bone syndrome after successful parathyroidectomy for primary hyperparathyroidism: A prospective study","volume":"110","author":"Salman","year":"2021","journal-title":"Scand. J. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Coman, A., Tarta, C., Isaic, A., Marian, M., Olariu, S., Ardelean, A., Macovei-Oprescu, A.M., Roland, F., Pupca, G.N., and Latcu, S. (2025). Predictors of Hungry Bone Syndrome After Parathyroidectomy in Secondary Hyperparathyroidism: A Narrative Review of Bone Turnover Biomarkers and Risk Prediction Tools. J. Clin. Med., 14.","DOI":"10.3390\/jcm14217849"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"3259","DOI":"10.1097\/00029330-201409200-00013","article-title":"Preoperative serum alkaline phosphatase: A predictive factor for early hypocalcaemia following parathyroidectomy of primary hyperparathyroidism","volume":"127","author":"Sun","year":"2014","journal-title":"Chin. Med. J."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1186\/s40842-024-00183-8","article-title":"Multiple fractures due to hungry bone syndrome following parathyroidectomy: A clinical case report and review of literature","volume":"10","author":"Tavakoli","year":"2024","journal-title":"Clin. Diabetes Endocrinol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e70070","DOI":"10.1002\/edm2.70070","article-title":"Predictors of Hypocalcemia Post Parathyroidectomy for Primary Hyperparathyroidism; a Single Center Study","volume":"8","author":"Obeidat","year":"2025","journal-title":"Endocrinol. Diabetes Metab."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"50","DOI":"10.14341\/serg12824","article-title":"Prediction of the Development of Hypocalcemia in Patients with PHPT 1\u20133 Days after Parathyroidectomy","volume":"17","author":"Elfimova","year":"2023","journal-title":"Endocr. Surg."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.jss.2025.01.003","article-title":"Changes in Bone Mineral Density After Parathyroidectomy in Patients With Primary Hyperparathyroidism","volume":"306","author":"Song","year":"2025","journal-title":"J. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1007\/s00268-022-06756-x","article-title":"Parathyroidectomy for Normocalcemic Primary Hyperparathyroidism is Associated with Improved Bone Mineral Density Regardless of Postoperative Parathyroid Hormone Levels","volume":"47","author":"Lui","year":"2023","journal-title":"World J. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"61","DOI":"10.5106\/jjshns.27.61","article-title":"Hypocalcemia after the surgery for primary hyperparathyroidism","volume":"27","author":"Sakai","year":"2017","journal-title":"J. Jpn. Soc. Head Neck Surg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s13304-025-02086-4","article-title":"Correlation between parathyroid adenoma volume and perioperative outcomes in primary hyperparathyroidism: Does the size matter?","volume":"77","author":"Fiore","year":"2025","journal-title":"Updates Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"611","DOI":"10.7150\/ijms.4861","article-title":"Pre-operative serum alkaline phosphatase as a predictor for hypocalcemia post-parathyroid adenectomy","volume":"9","author":"Loke","year":"2012","journal-title":"Int. J. Med. Sci."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/cen.15268","article-title":"The Effect of Preoperative Biochemical Parameters on the Development of Hungry Bone Syndrome After Surgery for Primary Hyperparathyroidism","volume":"103","author":"Hadi","year":"2025","journal-title":"Clin. Endocrinol."},{"key":"ref_19","first-page":"1674","article-title":"The effect of parathyroidectomy on bone mineral density in primary hyperparathyroidism","volume":"49","author":"Beysel","year":"2019","journal-title":"Turk. J. Med. Sci."},{"key":"ref_20","first-page":"455","article-title":"Early parathyroid hormone (PTH) level as a predictor of post-surgical hypoparathyroidism","volume":"124","author":"Ossola","year":"2024","journal-title":"Acta Chir. Belg."},{"key":"ref_21","doi-asserted-by":"crossref","unstructured":"Scott-Coombes, D., Stechman, M., Patel, N., and Egan, R. (2024). Intraoperative parathyroid hormone assay benefits surgery for primary hyperparathyroidism when preoperative localisation is negative or not performed. Ann. R. Coll. Surg. Engl., Epub ahead of printing.","DOI":"10.1308\/rcsann.2024.0051"},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Xu, J., Kong, N., Bai, N., Zhang, Z., Cui, A., Tan, S., and Xu, Q. (2024). Risk factors for postoperative severe hypocalcemia in patients with hyperparathyroidism: A retrospective study. BMC Endocr. Disord., 24.","DOI":"10.1186\/s12902-024-01620-6"},{"key":"ref_23","first-page":"1065","article-title":"Parathyroid diseases and metabolic syndrome","volume":"46","author":"Modica","year":"2023","journal-title":"J. Endocrinol. Investig."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s12022-022-09709-1","article-title":"Overview of the 2022 WHO Classification of Parathyroid Tumors","volume":"33","author":"Erickson","year":"2022","journal-title":"Endocr. Pathol."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/4\/636\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T11:49:48Z","timestamp":1771847388000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/4\/636"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,22]]},"references-count":24,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["diagnostics16040636"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16040636","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,22]]}}}