Document Detail

Revisiting lithium-associated hyperparathyroidism in the era of intraoperative parathyroid hormone monitoring.
MedLine Citation:
PMID:  16360387     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chronic lithium therapy may cause hyperparathyroidism (HPT). The utility of intraoperative parathyroid hormone monitoring (IOPTH) in these patients is unknown. The authors' hypothesis was that multiglandular disease is more common in these patients, and the ability of IOPTH to predict cure may be limited. METHODS: Twelve patients had HPT during chronic lithium therapy and underwent parathyroidectomy with IOPTH. Criteria for curative resection were a decrease > or =50% from baseline and into the normal range. Calcium and PTH levels were measured during follow-up. RESULTS: Preoperatively, mean calcium was 11.0 +/- 0.1 mg/dL, and PTH was 116 +/- 14 pg/mL. Fifty percent of patients had multiglandular disease confirmed by IOPTH levels. Mean IOPTH decrease from baseline was 74 +/- 4%. Although 10 of 12 patients met criteria for curative resection, only 8 remain normocalcemic. The 2 patients who did not meet criteria remain normocalcemic. Mean postoperative calcium for all patients was 9.5 +/- 0.2 mg/dL. Of the 10 normocalcemic patients, 4 also have hyperparathormonemia (mean PTH, 119 +/- 19 pg/mL). CONCLUSIONS: The incidence of multiglandular disease in HPT after chronic lithium exposure is higher than standard HPT. The ability of IOPTH to predict durable normocalcemia is limited. Bilateral neck exploration should be considered for these patients regardless of whether IOPTH monitoring is used.
Jonathan C Hundley; Derek T Woodrum; Brian D Saunders; Gerard M Doherty; Paul G Gauger
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Surgery     Volume:  138     ISSN:  0039-6060     ISO Abbreviation:  Surgery     Publication Date:  2005 Dec 
Date Detail:
Created Date:  2005-12-19     Completed Date:  2006-02-16     Revised Date:  2007-03-08    
Medline Journal Info:
Nlm Unique ID:  0417347     Medline TA:  Surgery     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1027-31; discussion 1031-2     Citation Subset:  AIM; IM    
Division of Endocrine Surgery, Department of Surgery, University of Michigan, Ann Arbor, MI 48109-0331, USA.
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MeSH Terms
Antimanic Agents / adverse effects*
Bipolar Disorder / drug therapy
Hyperparathyroidism / blood,  chemically induced*,  surgery*
Lithium Compounds / adverse effects*
Middle Aged
Monitoring, Intraoperative*
Parathyroid Hormone / blood*
Predictive Value of Tests
Retrospective Studies
Treatment Outcome
Reg. No./Substance:
0/Antimanic Agents; 0/Lithium Compounds; 0/Parathyroid Hormone

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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