Background: During parathyroidectomy for primary hyperparathyroidism (pHPT), intraoperative parathyroid hormone (IOPTH) levels are used to confirm removal of all hyperfunctioning parathyroid tissue. The phenomenon of elevated parathyroid hormone (PTH) levels with normocalcemia after curative parathyroidectomy, seen in up to 40% of patients, continues to be an unexpected and unexplained finding. We therefore investigated whether postoperative PTH levels are as reliable as IOPTH levels in predicting cure after surgery for pHPT.
Methods: We reviewed our prospective database of consecutive patients undergoing surgery for pHPT between December 1999 and November 2004. Curative parathyroidectomy was defined as normocalcemia 6 months or longer postoperatively.
Results: A total of 328 patients who underwent 330 operations for pHPT had IOPTH measurements and serum follow-up calcium levels at 6 months or longer. Surgery was curative in 315 (95.5%) operations. IOPTH levels correctly predicted operative success in 98.2% (positive predictive value [PPV]. Postoperatively, the PPV of a normal PTH level at 1 week, 3 months, and 6 months was 97.1%, 97.3%, and 96.5%, respectively. Of all patients with an elevated postoperative PTH level at 1 week, 3 months, or 6 months, only 13.7%, 14.3%, and 14%, respectively, were not cured.
Conclusions: Normal postoperative PTH levels reliably predict operative success. However, they do not improve upon results predicted by IOPTH levels. Elevated postoperative PTH levels do not predict operative failure in most patients. We propose that PTH measurements after surgery for pHPT may be misleading, costly, and not indicated in normocalcemic patients.
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Increase in serum parathyroid hormone level intraoperatively after parathyroidectomy for primary hyperparathyroidism.
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Division of Radiology, Hotel Dieu de France Hospital, Saint-Joseph University, Beirut, Lebanon.
Background: To evaluate the significance of increased of intraoperative parathyroid hormone(IOPTH) 10 min after parathyroidectomy in primary hyperparathyroidism.
Methods: All patients underwent parathyroidectomy were retrospectively included. Following the results of IOPTH, three groups were defined: Group 1: increased of IOPTH, Group 2: <50 % decreased of IOPTH, and Group 3: >50 % decreased of IOPTH.
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JAMA Otolaryngol Head Neck Surg
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Department of Health Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Importance: Intraoperative parathyroid hormone (IOPTH) monitoring is recommended by the American Association of Endocrine Surgeons for use during parathyroidectomy for patients with primary hyperparathyroidism (PHPT), but there is no clinician consensus regarding the IOPTH monitoring criteria that optimize diagnostic accuracy.
Objective: To evaluate and rank the diagnostic properties of IOPTH monitoring criteria used during surgery for patients with PHPT.
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The predictive role of intraoperative parathyroid hormone measurement on postoperative parathyroid function in patients undergoing total thyroidectomy.
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Department of Thyroid Surgery, China-Japan Union Hospital of Jilin University, Jilin Provincial Key Laboratory of Translational Medicine in Surgery, Jilin Provincial Engineering, Laboratory of Thyroid Disease Prevention and Treatment, 126 Xiantai Street, Changchun, 130033, China.
Article Synopsis
- Hypocalcemia is a frequent issue after total thyroidectomy, mainly due to potential damage to the parathyroid glands during the procedure.* -
- The study evaluated the effectiveness of intraoperative parathyroid hormone (IOPTH) levels in predicting hypocalcemia and monitoring parathyroid recovery in 164 patients who underwent total thyroidectomy.* -
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University of New Mexico Health Sciences Center, Department of Surgery, Division of Otolaryngology Head and Neck Surgery, Albuquerque, NM, USA.
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A new approach for perioperative parathyroid hormone (PTH) measurement to establish cure in patients with primary hyperparathyroidism.
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