Can the use of intraoperative intact parathyroid hormone monitoring be abandoned in patients with hyperparathyroidism?

Background: Ultrasound (US) and technetium-99m sestamibi scintigraphy (MIBI) are used to determine the localization of abnormal glands in cases of primary hyperparathyroidism (PHPT). Intraoperative intact parathyroid hormone (iPTH) monitoring is a reliable examination used to cure PHPT. The aim was to assess the necessity of intraoperative iPTH monitoring.

Methods: Sixty patients were examined using preoperative MIBI and US. iPTH was measured at 3 time points: (1) at the start of surgery; (2) 10 minutes after gland resection; and (3) more than 60 minutes after surgery. We defined a decreased iPTH level as an iPTH measured 10 minutes after resection that was less than 50% of the preoperative level.

Results: The iPTH of 55 patients with concordant lesions decreased to within the normal range more than 60 minutes after surgery.

Conclusions: It is not necessary to monitor intraoperative iPTH when single concordant lesions are preoperatively identified on both MIBI and US.