ObjectiveTo explore the clinical significance of detecting serum intact parathyroid hormone (iPTH) and drainage fluid parathyroid hormone (dPTH) after thyroidectomy in forecasting parathyroid function.MethodsThe clinical data of 95 thyroidectomy patients in the same treatment group from March 2018 to September 2018 were retrospectively analyzed, which in the Department of Thyroid-Breast Surgery, the Second Affiliated Hospital of Kunming Medical University. According to the surgical method, the patients were divided into 3 groups: isthmus and unilateral thyroidectomy (partial resection group, n=33), total thyroidectomy (total resection group, n=33) and total thyroidectomy and central lymph node excision (radical resection group, n=29). The negative pressure drainage tube was placed in the operative area. The iPTH and serum calcium were detected before and the first day after operation. The dPTH was detected in the first day and the second day after operation. Serum calcium, iPTH and dPTH were statistically analyzed.ResultsThere were no significant differences in operative time, hospital stay and blood loss between the total resection group and the radical resection group (P>0.05), but the partial resection group were all less than the other two groups (P<0.01). On the first day after operation, the iPTH in the three groups were lower than that before operation, and the iPTH was significantly decreased in the total resection group and the radical resection group, with statistically significant difference (P<0.05). The dPTH in the three groups were significantly increased on the first and second day after operation (P<0.05), but there was no statistically significant difference between the three groups (P>0.05). There was no statistically significant difference in serum calcium between the three groups on the first day after operation (P>0.05).ConclusionsThe levels of iPTH, dPTH and serum calcium after thyroidectomy can comprehensively forecast the parathyroid function. Preventive calcium supplementation can reduce the occurrence of postoperative symptomatic hypocalcemia, which is conducive to the recovery of parathyroid function.
Objective To review the progress of mechanism of parathyroid hormone (PTH) and parathyroid hormone-related protein (PTHrP) on normal and osteoarthritis (OA) cartilage and subchondral bones. Methods Recent 1iterature about the effects of PTH and PTHrP on normal and OA cartilage was reviewed. Results PTH and PTHrP can repress the hypertrophic differentiation and apoptosis of chondrocytes and promote their prol iferation, which has a protection effect on chondrocytes of OA; osteoblasts from subchondral bone of OA show a decreased reaction to PTH. Conclusion PTHand PTHrP may delay and protect the progression of OA, which involves in regulating cartilage degeneration and subchondral bone remodl ing through many kinds of signal pathway.
【摘要】 目的 观察重组人甲状旁腺激素（1-34）[rhPTH（1-34）]治疗骨质疏松症患者骨密度的疗效和安全性。 方法 采用自身前后对照临床研究，纳入2008年3-5月就诊的原发性骨质疏松症患者共39例，予rhPTH（1-34） 20 μg 1次/d皮下注射，疗程18个月。治疗期间均同时口服钙制剂600 mg/d及维生素D3 125 U/d作为基础治疗。患者治疗前采用双能X线检测腰2~4椎体（L2~4）和股骨颈骨密度（BMD）、肝肾功能、血钙、血磷，治疗后6、12、18个月复查BMD和上述生化指标改变，记录患者不良事件，对患者治疗前后L2~4、股骨颈BMD变化进行对比分析。 结果 35例患者完成全疗程治疗，其中男2例，女33例；平均年龄65岁，平均病程6.5年；治疗6、12、18个月时L2~4 BMD均较治疗前明显提高（Plt;0.01），而股骨颈BMD在治疗6、12个月时改善不明显（Pgt;0.05），18个月时表现出较治疗前明显增加（Plt;0.01）；腰椎平均BMD增长率为12.27%，股骨颈BMD增长率为4.11%；治疗期间不良反应少，均不需特殊处理而自行好转。 结论 rhPTH（1-34）治疗原发性骨质疏松症安全有效，对改善椎体BMD疗效迅速明显，对改善股骨颈BMD起效慢；适用于绝经后骨质疏松和老年性骨质疏松症患者。【Abstract】 Objective To observe the therapeutic effect of recombinant human parathyroid hormone (1-34) [rhPTH(1-34)] on the improvement of bone mineral density (BMD) in patients with primary osteoporosis. Methods A before and after self control study was performed on 39 patients with primary osteoporosis from March to May 2008. The patients underwent the subcutaneous injection with rhPTH (1-34) 20 μg/d for 18 months. All patients were given oral calcium (Ca 600 mg+Vit D3 125 U per day) as primary drug treatment. BMD of lumbar spine (L2-L4) and femur neck, serum calcium, and serum phosphate were measured before and 6, 12, and 18 months after the treatment. All of the adverse reactions were recorded. Results A total of 35 patients finished the trial,including two males and 33 females with the average age of 65 years and the course of disease of (6.54±4.30) years. BMD of lumbar spine (L2-L4) significantly increased 6, 12, and 18 months after treatment (Plt;0.01). There was no significant difference of femur neck BMD 6 and 12 months after treatment (Pgt;0.05), whereas by the end of the treatment, it improved significantly (Plt;0.01). The average increase rate was 12.27% in lumbar spine (L2-L4) and was 4.11% in femur neck BMD. There were a few adverse reactions during the therapeutic process, most of which were tolerable and self-restored. Conclusion rhPTH(1-34) is an effective and safe drug in treating primary osteoporosis. It can increase lumbar spine BMD rapidly and raise femur neck BMD gradually. It is applicable for postmenopausal osteoporosis and senile osteoporosis.
ObjectiveTo compare the clinical effects of unilateral neck exploration (UNE) and direct minimally invasive parathyroidectomy (DPT) in the treatment of primary hyperparathyroidism (PHPT). MethodsThe clinical datas of 87 PHPT patients treated with intraoperative parathyroid hormone monitoring (IPM) -assisted UNE and DMIP in Guizhou Provincial People’s Hospital between January 2016 and December 2021 were analyzed retrospectively. ResultsThe average age of patients was (47.5±13.1) years, and there were 24 males (27.6%) and 63 females (72.4%). The pathological types of 87 cases were parathyroid adenoma in 78 cases (89.7%), atypical parathyroid adenoma in 5 cases (5.7%), parathyroid hyperplasia in 4 cases (4.6%), and no parathyroid carcinoma. Two cases (2.3%) developed recurrent laryngeal nerve injury, and 3 cases (3.4%) developed postoperative persistent hyperparathyroidism, of which 1 (1.1%) case underwent secondary surgery. There were no significant differences in the incidence of recurrent laryngeal nerve injury (2.0% vs. 2.6%, P=0.855) and postoperative persistent hyperparathyroidism between the UNE group and the DMIP group (2.0% vs. 5.3%, P=0.713). However, the intraoperative bleeding volume, operative time, hospitalization time, incision length, and pain score in the DMIP group were significantly less than or shorter than or lower than those in the UNE group (P<0.001). ConclusionThere is no significant difference in the efficacy between the DMIP and UNE in the treatment of PHPT, but DMIP can significantly shorten the operative time and hospitalization time, and reduce the trauma.
ObjectiveTo summarize the variation of parathyroid hormone (PTH) after thyroidectomy and the influence factors of postthyroidectomy hypocalcemia (PHC). MethodsClinical data of 95 patients who underwent thyroidectomy in Affiliated Shengjing Hospital of China Medical University from Jan. 2015 to Dec. 2015 were analyzed retrospectively. ResultsOf the 95 patients, there were 27 patient (28.42%) suffered from PHC (PHC group), and levels of serum calcium in the other 68 patients (71.58%) were normal (normal group). There was no significant difference in levels of serum calcium and PTH between the PHC group and normal group before operation (P > 0.05), but levels of serum calcium and PTH in PHC group were both lower than corresponding index of normal group after operation (P < 0.05). The levels of serum calcium and PTH both decreased in PHC group after operation (P < 0.05), and only PTH level decreased in normal group after operation (P < 0.05). PHC was related with type of operation, who underwent two-side operation had higher risk of PHC (P < 0.05), but there was no significant relationship between PHC and gender or age (P > 0.05). ConclusionsPTH is an important factor for PHC. In addition, it is easier to occur PHC when the operative range become bigger.
ObjectiveTo investigate the clinical value of fine needle aspiration cytology (FNAC) combined with washout fluid detection of parathyroid hormone (PTH) in identifying parathyroid glands during thyroid cancer radical thyroidectomy. MethodsA total of 108 patients who underwent thyroid cancer radical thyroidectomy in Rizhao Central Hospital from June 2020 to December 2022 were selected as the study subjects. During the surgery, highly suspected parathyroid tissues were punctured with fine needle aspiration. FNAC and washout fluid were collected for PTH detection. Using the results of postoperative histopathological examination as the gold standard, the accuracy of different methods in identifying parathyroid glands during surgery was analyzed. ResultsAmong the 73 positive cases, the PTH level in the washout fluid was (591.20±84.30) pg/mL, while in the 35 negative cases, it was (18.69±2.53) pg/mL. The PTH level was significantly higher in the positive cases compared to the negative cases (P＜0.05). Postoperative routine histopathological examination confirmed parathyroid tissues in 91 cases, while in 17 cases, they were confirmed as adipose tissues (11 cases) or lymphoid tissues (6 cases). In the 17 cases confirmed as non-parathyroid tissues, both two methods considered them as non-parathyroid tissues. The sensitivity of puncture eluent in detecting PTH was 80.22% (73/91), that of cytological smear was 70.33% (64/91), and that of puncture eluent combined with cytological smear was 94.50% (86/91). There was no significant difference between the sensitivity of puncture cytology smear and puncture eluent in detecting PTH (P＞0.05). The sensitivity of combined detection of the two methods was higher than that of individual detection, and the difference was statistically significant (P<0.05). ConclusionThe combined detection of PTH by fine needle puncture smear and eluent can improve the accuracy of identification of parathyroid gland during radical thyroidectomy, and is beneficial to the identification and protection of parathyroid gland during surgery.
Objective To investigate the way to culture human parathyroid cells and to investigate its secretory function. Methods After digested by collagenase, parathyroid cells were isolated to get the original generation cells, then the cells were cultured and passaged, and morphological changes of original generation cells and passage cells were observed on every day. The parathyroid hormone(PTH) level secreted by the original generation cells and passage cells were measured on the 1st, 5th, 10th, 15th, and 20th day(original generation cells only) respectively. Results The cellular morphology was complete after digestion. On the 2nd day, most of the parathyroid cells had adhered and spreaded, on the 3rd day, all cells had spread. There was no very obvious changes on these cells after cultured for 4-15 days. From 16 to 20 days, some parathyroid cells went senescence. On the 1st day, all of the passage cells, which were fusiform and little bigger than those of the original generation cells, had adhered and spreaded. From 2 to 15 days, there was no very obvious changes. The concentration of PTH in original generation cells begin to decreased significantly on the 10th day (P < 0.01). The concentration of PTH in passage cells were all lower than those of original generation cells at the same corresponding time, but there were no significant difference on the PTH level on 5th day and 1st day, 10th day and 5th day, 15th day and 10th day in passage cells (P > 0.05). Conclusion Parathyroid cells which were cultured within 10 days possess well morphologic structure and have the strongest secretory function. Although the passage cells still possess secretory function, it is greatly inferior to original generation cells. At last, we consider that original generation cells cultured within 10 days can be regarded as the source of allogeneic cell transplantation.
ObjectiveTo summarize the research status of normocalcemic parathormone elevation after parathyroidectomy for patients with primary hyperparathyroidism. MethodsThe related literatures on normocalcemic parathormone elevation after parathyroidectomy were collected and reviewed. ResultsMost of the patients with primary hyperparathyroidism received radical treatment postoperation. NPE didn't predict failure of operation. The relationship between normocalcemic parathormone elevation and recurrent primary hyperparathyroidism remained to be further explored. Patients with normocalcemic parathormone elevation after parathyroidectomy had a higher risk of cardiovascular disease. Postoperative vitamin D and calcium supplementation could reduce the incidence of normocalcemic parathormone elevation. ConclusionsThe clinical significance of normocalcemic parathormone elevation is still unknown at present. Further researches of multicenter, huge sample, and long-term follow-up will be necessary.
Objective To analysis causes of reoperation for primary hyperparathyroidism and its clinical characteristics. Method The clinical data of the patients with primary hyperparathyroidism who had undergone reoperation from January 1993 to May 2017 were retrospectively analyzed. Results A total of 11 patients underwent reoperation were collected in the 226 patients with primary hyperparathyroidism. Of the 11 cases, 8 cases underwent twice operations, 2 cases underwent thrice operations, 1 case underwent quintic operation. After the initial operation, 3 cases were persistent diseases and 7 cases were recurrent diseases, 1 patient was not defined as the persistent or recurrent disease. The main clinical manifestations before the reoperation were fatigue, pain in joints, bones, or muscle. The reasons for reoperation included 3 cases of ectopic parathyroid lesions, 3 cases of recurrent parathyroid carcinomas, 1 case of enlarged operation extent for parathyroid carcinoma, 2 cases of regrowth of double parathyroid aedomas, 1 case of missing adenoma, 1 case of parathyroid hyperplasia. Among the location examinations, the 99Tcm-MIBI was most sensitivity (8/9). Eight cases were received reoperation on the original incision, and the remaining 3 ectopic parathyroid lesions on the new incision. After the reoperation, 2 patients were lost of follow-up, 1 patient died, and the remaining 8 patients had no recurrences during follow-up period. Conclusion A comprehensive approach with multiple imageology examinations which attribute to accurate location of lesions, experienced surgeons and well knowledge of parathyroid anatomy and embryology help to descend reoperation ratio and improve success rate of reoperation.