EXPERIENCE IN THE SURGICAL TREATMENT OF SECONDARY HYPERPARATHYROIDISM WITH USING INTRAOPERATIVE MONITORING OF PARATHYROID HORMONE
A prospective observational analysis of the use of intraoperative monitoring of intact parathyroid hormone (iPTH) in the surgical treatment of secondary hyperparathyroidism in 22 patients on dialysis replacement renal therapy was conducted. All patients underwent total parathyroidectomy with autotransplantation and monitoring of iPTH. To assess the effectiveness of monitoring, iPTH indices were used in the first 24 hours after the operation and within 1-16 months after the operation. For a positive result of the monitoring, a decrease in iPTH of 70% or more from the baseline level of iPTH was considered, 10 minutes after removal of all parathyroid glands. For a positive result of surgery, a decrease iPTH after a day below 60 pg/ml was considered. In the long-term postoperative period, the outcome was assessed by the level of iPTH: less than 150 pg/ml - hypothyroidism, 150-300 pg/ml - target values, more than 300 pg/ml - persistence and relapse of the disease. Operational characteristics of intraoperative monitoring of iPTH, when compared with iPTH in the first day after surgery: sensitivity - 78%, specificity - 25%, accuracy - 68%, predictive value of positive result - 82%, predictive value of negative result - 75%. 13 of 22 patients were examined at various times (1-16 months) after the operation. The following operational characteristics of intraoperative monitoring of iPTH in the long-term postoperative period: sensitivity - 70%, specificity - 33%, accuracy - 62%, positive predictive value - 78%, negative value - 67%. The obtained data confirms the urgency of the discussion on intraoperative monitoring of iPTH and determines the need for improvement of the method for the treatment of severe secondary hyperparathyroidism in patients undergoing dialysis renal replacement therapy.