Using parathyroid hormone spikes during parathyroidectomy to guide intraoperative decision-making

• Published in: The Journal of surgical research Vol. 209; pp. 162 - 167
• Main Authors: Carr, Azadeh A., MD, Yen, Tina W., MD, MS, Wilson, Stuart D., MD, Evans, Douglas B., MD, Wang, Tracy S., MD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2017
• Subjects: Adult; Aged; Aged, 80 and over; Clinical Decision-Making; Female; Humans; Hyperparathyroidism, Primary - surgery; Intraoperative Care; Intraoperative parathyroid hormone; Male; Middle Aged; Minimally Invasive Surgical Procedures - statistics & numerical data; Monitoring, Physiologic - methods; Multigland disease; Parathyroid; Parathyroid Hormone - blood; Parathyroidectomy; Retrospective Studies; Single gland disease; Surgery; Young Adult; Single gland disease; Intraoperative parathyroid hormone; Parathyroidectomy; Parathyroid; Multigland disease
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.10.006

Abstract Background Intraoperative parathyroid hormone (IOPTH) level monitoring is a useful adjunct to parathyroidectomy for primary hyperparathyroidism (pHPT). Occasionally, increases (“spikes”) in IOPTH levels from the preoperative baseline PTH may occur which may lead to longer operative times and/or more extensive neck exploration. The aim of this study was to determine if the extent of IOPTH increase predicts single gland disease (SGD). Methods This is a retrospective review of a prospective parathyroid database of patients undergoing parathyroidectomy for sporadic pHPT from 1999-2013. Extent of PTH spike was calculated by the difference in IOPTH level at time of gland excision and baseline: Group 1 had a decrease in IOPTH, Group 2 had IOPTH increase 1-3 times above baseline, and Group 3 had IOPTH increase >3 times above baseline. Results Of the 900 patients in the cohort, there were 634 (70%) patients in Group 1, 234 (26%) in Group 2, and 32 (4%) in Group 3. SGD was identified in 88%, 78% and 100% of patients in Groups 1, 2 and 3, respectively. The median gland weight in Group 3 (920mg) was significantly larger than those in Groups 1 and 2 (440 and 460mg, respectively; p<0.001). Conclusions IOPTH spikes occur in nearly one-third of patients undergoing parathyroidectomy for sporadic pHPT. Patients with extensive IOPTH increase are more likely to have larger SGD, whereas patients with moderate IOPTH increases have increased incidence of multi-gland disease. In patients with significant elevation in IOPTH levels and larger glands, no further surgical exploration may be indicated.