Preoperative total parathyroid volume is an independent marker to predict recurrence for secondary hyperparathyroidism.

Purpose: This study aimed to explore the value of preoperative total parathyroid volume (TPV) as a marker for predict recurrence of renal secondary hyperparathyroidism (SHPT).

Methods: We identified 28 patients with recurrence and 128 without recurrence who underwent total parathyroidectomy with autotransplantation (tPTX + AT) at our institution between 2015 and 2022. The TPV and postoperative recurrence information of the patients were recorded. Within the intergroup comparison, data obtained from the recurrence and non-recurrence groups were evaluated using the t-test. Univariate and multivariate analyses were performed according to the regression model to determine factors that were significant in predicting postoperative recurrence. The cutoff value of TPV was determined using a receiver operating characteristic (ROC) curve.

Results: The mean TPV of recurrence and no-recurrence groups were 2.99 ± 1.52 cm³ and 1.73 ± 1.19 cm³, respectively (p = 0.007). In univariate analysis, female sex, total parathyroid volume > 1.99 cm³, serum PTH > 928.37 pg/mL and p > 1.59 mmol/L were independent factors for SHPT recurrence. In multivariable analysis, TPV > 1.99 cm³, serum parathyroid hormone (PTH) > 928.37 pg/mL and p > 1.59 mmol/L were independent factors for SHPT recurrence. The ability of TPV to distinguish between recurrence and non-recurrence was evaluated using the ROC curve. The cutoff value of TPV was estimated as 2.65 cm³. With this value, sensitivity was found as 60.70%, specificity was 89.80%, and AUC was 0.80 (p < 0.001, confidence interval =0.719-0.882).

Conclusion: According to the data in this study, it can be said that TPV can be used to distinguish recurrence from no-recurrence. Most importantly, TPV can be used to identify SHPT recurrence.