Endocrinol Metab.  2014 Dec;29(4):464-469. 10.3803/EnM.2014.29.4.464.

Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism

• Cho E
• Chang JM
• Yoon SY
• Lee GT
• Ku YH
• Kim HI
• Lee MC
• Lee GH
• Kim MJ

• KMID: 2384243
• DOI: http://doi.org/10.3803/EnM.2014.29.4.464

Abstract

BACKGROUND
The intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT.
METHODS
We retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted.
RESULTS
The sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration.
CONCLUSION
The IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

Keyword

Parathyroid hormone; Parathyroid neoplasms; Hyperparathyroidism, primary; Technetium Tc 99m sestamibi; Ultrasonography

MeSH Terms

Humans
Hyperparathyroidism, Primary*
Neck
Parathyroid Glands
Parathyroid Hormone*
Parathyroid Neoplasms
Parathyroidectomy
Radionuclide Imaging
Retrospective Studies
Technetium Tc 99m Sestamibi
Ultrasonography
Parathyroid Hormone
Technetium Tc 99m Sestamibi

Figure

• 

  Fig. 1 Intraoperative parathyroid hormone assay. Percent change in parathyroid hormone (PTH) levels when using preoperative PTH levels as a baseline (shown as red circle) and when using pre-excision PTH levels as a baseline (shown as yellow circle).

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