A 10-Year Experience in Intraoperative Parathyroid Hormone Measurements for Primary Hyperparathyroidism: A Prospective Study of 91 Previous Unexplored Patients

Abstract

Introduction. Primary hyperparathyroidism (PHP) is characteristically determined by high levels of calcium and high or inappropriate levels of parathyroid hormone (PTH). Technological advances have dramatically changed the surgical technique over the years once intraoperative parathyroid hormone (IOPTH) assay had allowed for focused approaches. Objective. To evaluate our 10-year experience in employing a rapid intraoperative PTH assay for PHP. Methods. A prospective cohort of 91 PHP-operated patients in a tertiary institution in São Paulo, Brazil, from June 2000 to April 2011. Results. We had 85 (93.4%) successful parathyroidectomies, 6 (6.6%) failed parathyroidectomies in 91 previous unexplored patients, and 5 (100%) successful remedial surgeries. The IOPTH was true-positive in 88.5%, true-negative in 7.3%, false-positive in 2.1%, and false-negative in 2.1% of the procedures. IOPTH was able to obviate additional exploration or to ask for additional exploration in 92 (95.8%) procedures. Conclusion. The IOPTH revealed to be an important technological adjunct in the current parathyroid surgery for PHP.

Analysis of PTH serum concentration from internal jugular veins of patients with primary hyperparathyroidism

“…We obtained a peripheral PTH drop greater than 50% in all cases 12 , and an average of 73.47% in the study.…”

“…Data were collected from medical records on gender, age, localizatory exams, surgery performed and complications. The surgical technique and PTH collection were performed according to the usual technique previously published 12 .…”

Intraoperative Parathyroid Hormone is a Valuable Indicator of Long Term Cure in Primary Hyperparathyroidism

“…Since it was first suggested by Nussbaum in 1988, intraoperative measurement of PTH has been extensively used to limit the extent of surgery for PHPT with high rate of success [9,10,[12][13][14][15][16][17][18]. When the classic "more than 50% drop" criterion is used, a peripheral PTH level decreasing more than 50% ten minutes after removal of the abnormal parathyroid glands predicts normal or low postoperative calcemia with an accuracy of 97-98% [19].…”

“…Nussbaum et al [8] were the first to use rapid intraoperative PTH (ioPTH) assessment to confirm the removal of all hyperfunctioning parathyroid tissue. The use of ioPTH has been validated by others as a useful tool to moniManuscript accepted for publication August 28, 2013 tor the success of the procedure [4][5][6][9][10][11][12][13][14].…”

Evolution of renal function in patients with primary hyperparathyroidism submitted to parathyroidectomy

“…The patients were operated by the same surgical team. Intraoperative PTH (ioPTH) was routinely collected, If ioPTH decay (ioPTH) was more than 50%, the surgery was considered to be a success 8,9 .…”