AI Article Synopsis

  • - IOPTH monitoring is crucial during surgery for primary hyperparathyroidism (PHPT) but has potential false-positive and false-negative rates of up to 10%, requiring surgeons to be well-informed about PTH dynamics and monitoring protocols.
  • - A case of a 64-year-old woman with a parathyroid tumor showed delayed IOPTH decrease yet resulted in a successful cure without further surgery, indicating that initial PTH levels and fragments can affect IOPTH readings.
  • - The study emphasizes the need to understand the factors leading to false-negative IOPTH results, such as hormone production and measurement methods, to minimize unnecessary additional surgical procedures.

Article Abstract

Background: Intraoperative parathyroid hormone (IOPTH) monitoring is a critical surgical adjunct for determining the extent of surgery for primary hyperparathyroidism (PHPT), with reported false-positive and false-negative rates of up to 10%. Surgeons must understand the parathyroid hormone (PTH) dynamics and select the appropriate IOPTH protocol and interpretation criteria for curative surgery.

Case Presentation: We present the case of a 64-year-old woman with a large cystic parathyroid tumor and PHPT who experienced a significant delay in IOPTH decrease but was cured without additional surgery. The patient's basal intact PTH was 96.2 pg/mL, which decreased to 93.3 pg/mL at 25 min and 72.4 pg/mL at 55 min after removal of the parathyroid tumor. In an attempt to elucidate its pathophysiology, 1-84 PTH levels were measured in stored serum. These results can also be attributed to the relatively low basal PTH levels, intact PTH spike, and high ratio of large carboxyl-terminal PTH fragments present. The patient had normal intact PTH and calcium levels at the 9-month postoperative visit.

Conclusions: As detailed reports on these phenomena are scarce, we discuss the causes of false-negative IOPTH results in terms of PTH production, secretion, metabolism, and differences in measurement methods to avoid unnecessary surgery.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11045703PMC
http://dx.doi.org/10.1186/s40792-024-01903-zDOI Listing

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