Ann Surg Treat Res.  2018 Feb;94(2):69-73. 10.4174/astr.2018.94.2.69.

Clinical usefulness of intraoperative parathyroid hormone monitoring for primary hyperparathyroidism

Affiliations
  • 1Department of Surgery, Ewha Womans University College of Medicine, Seoul, Korea.
  • 2Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. kyueunlee@snu.ac.kr
  • 3Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.
  • 4Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Abstract

PURPOSE
The availability of intraoperative parathyroid hormone (IOPTH) monitoring allows successful focused parathyroidectomy for primary hyperparathyroidism (pHPT). The objective of this study was to report our initial experience in IOPTH monitoring during parathyroid surgery for primary hyperparathyroidsim.
METHODS
Between May 2011 and February 2013, 37 patients underwent focused parathyroidectomy due to pHPT. IOPTH monitoring based on Miami criteria was used to confirm complete excision of hyperfunctioning parathyroid gland during surgery. Medical records of patients were reviewed retrospectively.
RESULTS
Preoperative mean maximal calcium level was 11.7 ± 0.9 mg/dL. Preoperative technetium (99mTc) sestamibi scan and ultrasonography identified 32 of 37 (86.5%) and 29 of 37 (78.4%) of abnormal parathyroid glands, retrospectively. Results of the 2 imaging modalities were discordant for 8 cases (21.6%). The mean pre-excision PTH level was 147.2 ± 201.5 pg/mL. At 5- and 10-minute post tumor resection, PTH levels were 65.3 ± 25.4 pg/mL and 47.5 ± 24.3 pg/mL, respectively. In all cases, IOPTH levels fell by at least 50% after removing all suspected abnormal glands. All patients had a successful return to normocalcemia after surgery (mean follow-up period: 60.2 ± 15.4 months).
CONCLUSION
Surgeon could confirm complete excision of abnormal hyperfunctioning parathyroid glands by IOPTH monitoring during surgery for pHPT. IOPTH monitoring can maximize performance of successful focused para thyroidectomy for pHPT, especially when preoperative imaging results are discordant.

Keyword

Focused parathyroidectomy; Parathyroid hormone monitoring; Primary hyperparathyroidism

MeSH Terms

Calcium
Follow-Up Studies
Humans
Hyperparathyroidism, Primary*
Medical Records
Parathyroid Glands
Parathyroid Hormone*
Parathyroidectomy
Retrospective Studies
Technetium
Thyroidectomy
Ultrasonography
Calcium
Parathyroid Hormone
Technetium

Figure

  • Fig. 1 The overall mean intraoperative parathyroid hormone (IOPTH) levels. PTH, parathyroid hormone.


Cited by  2 articles

A Case of Hyperparathyroidism Caused by Intrathyroidal Parathyroid Adenoma
Ki Ju Cho, Sang-Wook Park, Seongjun Won, Jin Pyeong Kim, Jung Je Park
Int J Thyroidol. 2021;14(1):42-45.    doi: 10.11106/ijt.2021.14.1.42.

Analysis of the cause and management of persistent laboratory abnormalities occurring after the surgical treatment of primary hyperparathyroidism
Ji-Eun Lee, Namki Hong, Jin Kyong Kim, Cho Rok Lee, Sang-Wook Kang, Jong Ju Jeong, Kee-Hyun Nam, Woong Youn Chung, Yumie Rhee
Ann Surg Treat Res. 2022;103(1):12-18.    doi: 10.4174/astr.2022.103.1.12.


Reference

1. Gil-Cardenas A, Gamino R, Reza A, Pantoja JP, Herrera MF. Is intraoperative parathyroid hormone assay mandatory for the success of targeted parathyroidectomy? J Am Coll Surg. 2007; 204:286–290.
2. Cayo AK, Sippel RS, Schaefer S, Chen H. Utility of intraoperative PTH for primary hyperparathyroidism due to multigland disease. Ann Surg Oncol. 2009; 16:3450–3454.
Article
3. Miccoli P, Berti P, Materazzi G, Massi M, Picone A, Minuto MN. Results of video-assisted parathyroidectomy: single institution's six-year experience. World J Surg. 2004; 28:1216–1218.
Article
4. Grant CS, Thompson G, Farley D, van Heerden J. Primary hyperparathyroidism surgical management since the introduction of minimally invasive parathyroidectomy: Mayo Clinic experience. Arch Surg. 2005; 140:472–478. discussion 478-9.
5. Bergenfelz AO, Jansson SK, Wallin GK, Martensson HG, Rasmussen L, Eriksson HL, et al. Impact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients. Langenbecks Arch Surg. 2009; 394:851–860.
Article
6. Bergenfelz AO, Hellman P, Harrison B, Sitges-Serra A, Dralle H. European Society of Endocrine Surgeons. Positional statement of the European Society of Endocrine Surgeons (ESES) on modern techniques in pHPT surgery. Langenbecks Arch Surg. 2009; 394:761–764.
Article
7. Mihai R, Simon D, Hellman P. Imaging for primary hyperparathyroidism--an evidence-based analysis. Langenbecks Arch Surg. 2009; 394:765–784.
Article
8. Siperstein A, Berber E, Barbosa GF, Tsinberg M, Greene AB, Mitchell J, et al. Predicting the success of limited exploration for primary hyperparathyroidism using ultrasound, sestamibi, and intra operative parathyroid hormone: analysis of 1158 cases. Ann Surg. 2008; 248:420–428.
9. Nussbaum SR, Thompson AR, Hutcheson KA, Gaz RD, Wang CA. Intraoperative measurement of parathyroid hormone in the surgical management of hyperparathyroidism. Surgery. 1988; 104:1121–1127.
10. Irvin GL 3rd, Dembrow VD, Prudhomme DL. Operative monitoring of parathyroid gland hyperfunction. Am J Surg. 1991; 162:299–302.
Article
11. Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL 3rd. Comparison of intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery. 2003; 134:973–979.
Article
12. Chen H, Sokoll LJ, Udelsman R. Outpatient minimally invasive parathyroidectomy: a combination of sestamibi-SPECT localization, cervical block anesthesia, and intraoperative parathyroid hormone assay. Surgery. 1999; 126:1016–1021.
Article
13. Bergenfelz A, Lindblom P, Tibblin S, Westerdahl J. Unilateral versus bilateral neck exploration for primary hyperparathyroidism: a prospective randomized controlled trial. Ann Surg. 2002; 236:543–551.
14. Goldstein RE, Blevins L, Delbeke D, Martin WH. Effect of minimally invasive radioguided parathyroidectomy on efficacy, length of stay, and costs in the management of primary hyperparathyroidism. Ann Surg. 2000; 231:732–742.
Article
15. Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients under going minimally invasive parathyroidectomy. Surgery. 2005; 138:583–587.
16. Wong W, Foo FJ, Lau MI, Sarin A, Kiruparan P. Simplified minimally invasive parathyroidectomy: a series of 100 cases and review of the literature. Ann R Coll Surg Engl. 2011; 93:290–293.
Article
17. Ryan JA Jr, Eisenberg B, Pado KM, Lee F. Efficacy of selective unilateral exploration in hyperparathyroidism based on localization tests. Arch Surg. 1997; 132:886–890. discussion 890-1.
Article
18. Arici C, Cheah WK, Ituarte PH, Morita E, Lynch TC, Siperstein AE, et al. Can localization studies be used to direct focused parathyroid operations? Surgery. 2001; 129:720–729.
Article
19. Chapuis Y, Fulla Y, Bonnichon P, Tarla E, Abboud B, Pitre J, et al. Values of ultrasonography, sestamibi scintigraphy, and intraoperative measurement of 1-84 PTH for unilateral neck exploration of primary hyperparathyroidism. World J Surg. 1996; 20:835–839.
Article
20. Irvin GL 3rd, Sfakianakis G, Yeung L, Deriso GT, Fishman LM, Molinari AS, et al. Ambulatory parathyroidectomy for primary hyperparathyroidism. Arch Surg. 1996; 131:1074–1078.
Article
21. Martin RC 2nd, Greenwell D, Flynn MB. Initial neck exploration for untreated hyperparathyroidism. Am Surg. 2000; 66:269–272.
22. Agcaoglu O, Aliyev S, Heiden K, Neumann D, Milas M, Mitchell J, et al. A new classification of positive sestamibi and ultrasound scans in parathyroid localization. World J Surg. 2012; 36:2516–2521.
Article
23. Yeh MW, Barraclough BM, Sidhu SB, Sywak MS, Barraclough BH, Delbridge LW. Two hundred consecutive parathyroid ultra sound studies by a single clinician: the impact of experience. Endocr Pract. 2006; 12:257–263.
24. Senchenkov A, Staren ED. Ultrasound in head and neck surgery: thyroid, parathyroid, and cervical lymph nodes. Surg Clin North Am. 2004; 84:973–1000. v
Article
25. Haciyanli M, Lal G, Morita E, Duh QY, Kebebew E, Clark OH. Accuracy of preoperative localization studies and intraoperative parathyroid hormone assay in patients with primary hyperparathyroidism and double adenoma. J Am Coll Surg. 2003; 197:739–746.
Article
26. Sugg SL, Krzywda EA, Demeure MJ, Wilson SD. Detection of multiple gland primary hyperparathyroidism in the era of minimally invasive parathyroidectomy. Surgery. 2004; 136:1303–1309.
Article
27. Fraker DL, Harsono H, Lewis R. Minimally invasive parathyroidectomy: benefits and requirements of localization, diagnosis, and intraoperative PTH monitoring. long-term results. World J Surg. 2009; 33:2256–2265.
Article
28. Barczynski M, Konturek A, Hubalewska-Dydejczyk A, Cichon S, Nowak W. Evaluation of Halle, Miami, Rome, and Vienna intraoperative iPTH assay criteria in guiding minimally invasive parathyroidectomy. Langenbecks Arch Surg. 2009; 394:843–849.
Article
Full Text Links
  • ASTR
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr