Abstract: TH-PO0218
Intraoperative Parathyroid Hormone Monitoring During Parathyroidectomy in Severe Secondary Hyperparathyroidism Due to Kidney Failure
Session Information
- Bone and Mineral Metabolism: Clinical Reports and Practice
November 06, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Castro Almanza, Carlos Antonio, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Canaviri, Vianca Anabel, Hospital Obrero No 1, La Paz, La Paz Department, Bolivia, Plurinational State of
- Cojuc, Gabriel, Harvard Medical School, Boston, Massachusetts, United States
- Calderón, Abril Jacqueline, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Zavala Miranda, Fernanda, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Velazquez-Fernandez, David, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
- Ramirez-Sandoval, Juan Carlos, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, CDMX, Mexico
Background
The utility of intraoperative parathyroid hormone (IOPTH) monitoring during parathyroidectomy to predict long-term intact PTH levels in renal failure remains uncertain.
Methods
Diagnostic accuracy study of IOPTH in a cohort of 47 patients with severe secondary hyperparathyroidism. IOPTH was measured pre-incision and at 10 and 30 min post-excision. Sensitivity, specificity, and AUC-ROC were assessed to predict surgical success, defined as sustained iPTH <300 pg/mL (KDOQI) or <9× the upper limit of normal (KDIGO) at 6 mo. All patients received postoperative calcium and active vitamin D to prevent hypocalcemia.
Results
Surgical success was achieved in 38 (80%) and 42 (89%) patients, according to the KDOQI and KDIGO criteria, respectively. Compared with the recurrence group, the KDOQI success group had significantly lower median 10-min IOPTH levels (212 pg/mL vs. 495 pg/mL, P<0.001) and 30-min IOPTH levels (189 pg/mL vs. 495 pg/mL, P<0.001). The percentage decline in IOPTH at 10 min was also greater in patients who experienced surgical success (92% vs. 85%, P=0.008). The AUCs for 10- and 30-min IOPTH to predict surgical success were 0.87 (95% CI 0.68–1.00) and 0.86 (95% CI 0.72–1.00), respectively. The AUCs for percentage decline in IOPTH at 10 and 30 min were 0.74 (95% CI: 0.59–0.89) and 0.75 (95% CI: 0.61–0.92), respectively. A 10-min IOPTH <270.7 pg/mL yielded 89% sensitivity and 59% specificity for predicting success (KDOQI). Similar trends were observed using the KDIGO criterion.
Conclusion
IOPTH <270 pg/mL at 10 min may predict long-term surgical success in secondary hyperparathyroidism. Percentage decline and 30-min IOPTH measurements provide limited additional value.
Outcomes based on a predicted iPTH <300 pg/mL at up to 6 months postoperatively.