OutcomeRole of intraoperative parathormone monitoring during parathyroidectomy in patients with discordant localization studies
Section snippets
Material and methods
A series of 225 consecutive patients with SPHPT underwent focused PTX with IPM at the University of Miami/Jackson Memorial Medical Center from July 2001 to June 2006. All patients with a secure biochemical diagnosis had MIBI scans and surgeon-performed ultrasonography (SUS) to localize parathyroid glands preoperatively. Indications for PTX followed the guidelines defined by the 2002 NIH Consensus Report.15 Focused PTX with IPM was attempted in all patients. The intraoperative criterion for
Results
Of the 225 consecutive patients who underwent focused PTX, 18 patients (8%) had prior PTX, and 11 patients (5%) had undergone previous thyroidectomy. A total of 213 patients (95%) had solitary parathyroid glands excised (209 hypersecreting glands, 4 carcinomas), and 12 patients (5%) had MGD. In all, 178 women and 47 men were included in the study with a mean age of 58 years (range, 16–89). The mean preoperative serum calcium was 11.9 mg/dL with a mean serum PTH level of 215 pg/mL. The mean
Discussion
In this report of 225 consecutive patients with MIBI and SUS studies who underwent focused PTX guided by IPM for SPHPT, there was a 97% operative success rate. These results are similar to those reported in which BNE was used in all patients or in those who had only concordant preoperative imaging studies.3, 4, 5, 6, 16 In this series, concordant localization studies were only observed in 62% of patients treated for SPHPT. In the remaining 38% of treated patients with discordant imaging
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Cited by (56)
Surgical treatment of double parathyroid adenomas in primary hyperparathyroidism: A clinical case
2020, International Journal of Surgery Case ReportsIntraoperative parathormone spikes during parathyroidectomy may be associated with multiglandular disease
2018, Surgery (United States)Citation Excerpt :Although not part of the current study, 44 patients had ioPTH spikes 3 times above the preincision level, with 2 having MGD (4.5%). Since this rate of MGD is consistent with rates published in the literature, ioPTH spikes should not warrant changes in current operative approach.12,18,19,21 Although the data were collected prospectively, this study is limited by its retrospective nature because other multiple intraoperative factors, such as the timing of blood draws and the degree of difficulty in locating glands, could not be captured in the database.
Is intraoperative parathyroid hormone monitoring necessary for primary hyperparathyroidism with concordant preoperative imaging?
2017, American Journal of SurgeryCitation Excerpt :The additional use of IOPTH in patients with two concordant preoperative studies lead to 100% cure of primary hyperparathyroidism in our patient population that would not have been achieved otherwise. While the results of other studies support the concept that IOPTH is essential during parathyroidectomy in patients with discordant localization studies8,9 and in patients with only a single positive preoperative localizing study,3,10 controversy remains on whether IOPTH is necessary in patients with two concordant preoperative imaging studies demonstrating a single abnormal parathyroid gland. The positive predictive value of dual localization studies with sestamibi and ultrasound varies at each institution and has been reported to be between 95 and 100%.1,8,11
Role of intraoperative PTH monitoring and surgical approach in primary hyperparathyroidism
2015, Annals of Medicine and SurgeryCitation Excerpt :Padma et al. (2013) [8] found that the confirmation by IOPTH use changed the surgical management in 66% of images which were equivocal and 29% were the imaging was positive. Our results agree with the study carried out by Lew et al. (2008) [9] where they demonstrated that operative management was changed with the use of IOPTH in 74% of patients with equivocal preoperative imaging. The use of IOPTH allowed 66% of these patients to undergo a less invasive unilateral neck exploration.
No Need to Abandon Focused Unilateral Exploration for Primary Hyperparathyroidism with Intraoperative Monitoring of Intact Parathyroid Hormone
2015, Journal of the American College of Surgeons
Presented at the 3rd Annual Academic Surgical Congress, Huntington Beach, California, February 2008.