Diagnostic Accuracy of Intraoperative Intact Parathyroid Hormone Monitoring for Surgical Outcomes of Secondary Hyperparathyroidism

Abstract

Background Intraoperative intact parathyroid hormone (IO-iPTH) monitoring has not reached a consensus in predicting surgical outcomes of secondary hyperparathyroidism. Here, we explore the predictive effect of IO-iPTH monitoring on surgical outcomes of secondary hyperparathyroidism as a potentially effective standard. Material/Methods We enrolled 119 patients who underwent total parathyroidectomy with autotransplantation from January 2016 to August 2019. Intact parathyroid hormone (iPTH) levels were tested 1 day before surgery (iPTH pre ), 10 min after glands resection (iPTH 10min ), and 1 and 7 days after the operation (iPTH d1 , iPTH d7 ). According to iPTH pre levels, patients were divided into a <2000 pg/ml group and a ≥2000 pg/ml group, and the cutoff values were compared. In patients with successful parathyroidectomy, the value of iPTH pre minus iPTH 10min (iPTH dec ) and relative-iPTH 10min were compared between groups. Results Using cutoff values, the predictive criterion was defined as iPTH 10min ≤314.5 pg/ml or relative-iPTH 10min ≤12.4%. In the iPTH pre ≥2000 pg/ml group, iPTH 10min had a higher predictive value (318 pg/ml vs 218 pg/ml) whereas relative-iPTH 10min had a lower predictive value (12.1% vs 20.3%). In patients with successful PTX, the iPTH dec value of the iPTH pre ≥2000 pg/ml group was significantly higher than that of the <2000 pg/ml group. Additionally, the relative-iPTH 10min was significantly lower in the ≥2000 pg/ml group than in the <2000 pg/ml group. Conclusions An intraoperative predictive criterion of iPTH 10min ≤314.5 pg/ml or relative-iPTH 10min ≤12.4% is associated with effectively predicting surgical success of secondary hyperparathyroidism. The predictive value is affected by iPTH pre level; therefore, a variable prediction standard based on iPTH pre levels shall be established.

A preoperative parathyroid scan is important for the total removal of the transplanted parathyroid tissue in recurrent secondary hyperthyroidism: A case report and literature review

“…Surgical success of secondary hyperparathyroidism was associated with an intraoperative predictive criterion of iPTH 10 minutes ≤ 314.5 pg/mL or relative-iPTH 10 minutes ≤ 12.4%. [ 4 ] There are 3 transplant methods including muscle, subcutaneous, and muscle plus subcutaneous. The efficiency differs from methods.…”