The additional value of intraoperative parathyroid hormone assessment is marginal in patients with nonfamilial primary hyperparathyroidism: a prospective cohort study

• Published in: The American journal of surgery Vol. 204; no. 1; pp. 1 - 6
• Main Authors: Twigt, Bas A., M.D, van Dalen, Thijs, M.D., Ph.D, Vollebregt, Anne M., M.D, Kortlandt, Wouter, M.D., Ph.D, Vriens, Menno R., M.D., Ph.D, Borel Rinkes, Inne H.M., M.D., Ph.D
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2012; Elsevier; Elsevier Limited
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Biomarkers - blood; Cohort Studies; Endocrine system; Endocrinopathies; Female; General aspects; Hospital costs; Humans; Hypercalcemia; Hyperparathyroidism, Primary - blood; Hyperparathyroidism, Primary - surgery; Intraoperative parathyroid hormone assessment; Localization; Male; Medical sciences; Middle Aged; Minimally invasive parathyroidectomy; Minimally Invasive Surgical Procedures - methods; Miscellaneous; Monitoring, Intraoperative - methods; Non tumoral diseases. Target tissue resistance. Benign neoplasms; Parathyroid Hormone - blood; Parathyroidectomy - methods; Parathyroids. Parafollicular cells. Cholecalciferol. Phosphocalcic homeostasis (diseases); Patients; Predictive Value of Tests; Primary hyperparathyroidism; Prospective Studies; Public health. Hygiene; Public health. Hygiene-occupational medicine; Scintigraphy; Surgery; Surgical outcomes; Tomography; Tumors; Ultrasonic imaging; United States > US; Hypercalcemia; Minimally invasive parathyroidectomy; Primary hyperparathyroidism; Intraoperative parathyroid hormone assessment; Endocrinopathy; Human; Hydroelectrolytic balance disorder; Calcium; Peptide hormone; Patient; Intraoperative; Parathyroidectomy; Inorganic element; Medicine; Prospective; Metabolic disorder; Treatment; Parathyroid diseases; Parathyroid hormone; Surgery; Cohort study; Primary; Hyperparathyroidism; Public health
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2011.07.017

Abstract Background The success of minimally invasive parathyroidectomy is attributed to evolving preoperative imaging techniques and intraoperative parathyroid hormone (IOPTH) measurement. The additional value of IOPTH measurement in patients undergoing surgery for primary hyperparathyroidism (pHPT) was evaluated. Methods Between 1999 and 2010 there were 119 patients who underwent surgery for pHPT at our institutions. In all patients, preoperative imaging was performed and IOPTH samples were collected prospectively but the results were not disclosed during surgery. Results Postoperative calcium level normalized in 114 patients (96%). The 5 surgical failures represented the maximum yield of IOPTH sampling. Three of these patients would have been identified intraoperatively by an inadequate IOPTH decrease, whereas IOPTH decreased inaccurately in the other 2 patients. In addition, in 1 of these 3 patients no abnormal gland was found during minimally invasive parathyroidectomy and subsequent conventional neck exploration. Therefore, only 2 reoperations would have been prevented (1.7%). Conclusions IOPTH would have changed the outcome in 2 patients, increasing the biochemical cure rate from 96% to 98%. We believe that although it can be helpful in certain cases, it may not be necessary routinely in patients treated for pHPT.