Intra-Operative Parathyroid Hormone Assay for Simplified Localization of Parathyroid Adenomas

Abstract

Lack of success in parathyroid surgery is usually due to failure to identify the abnormal parathyroid gland correctly at operation. The surgeon may be helped by rapid parathyroid hormone (PTH) assay in peripheral blood after removal of a suspected adenoma, and by frozen section histology, but these are not true localization techniques. We have adapted a non-isotopic immunoassay for rapid measurement of PTH in samples from the upper, middle and lower thyroid veins taken at operation, before exploration begins. Fifteen patients with primary hyperparathyroidism were operated on. In 10 the parathyroid adenoma was located easily, and was associated with high local venous PTH levels. In four patients the abnormal parathyroid was not immediately apparent but the assay indicated its location, which was confirmed after further exploration. In one patient there was no difference in PTH levels in the six venous samples. An ectopic adenomatous gland was successfully identified behind the thymus. The operation was successful in all patients as shown by a fall in the plasma calcium to the normal range. We conclude that intra-operative selective venous sampling and rapid PTH assay facilitates operative localization of parathyroid adenomas.

Rapid Intraoperative Immunoassay of Parathyroid Hormone and Other Hormones: A New Paradigm for Point-of-Care Testing

“…The rapid PTH assay allows for real-time analysis and feedback to the angiographer (58 ). Similarly, venous sampling on either side of the neck and sampling after tissue massage may aid in gland localization in the operating room (59 ). The assay has also been used to assay tissue, as an alternative to frozen section analysis, to confirm the identification of removed tissue as parathyroid (60 ).…”

Validation of a Rapid Parathyroid Hormone Assay and Intraoperative Measurement of Parathyroid Hormone in Dogs with Benign Naturally Occurring Primary Hyperparathyroidism

“…Correctly detecting the abnormal gland(s) can be difficult in some dogs, because visible changes in a parathyroid gland can be subtle and more than one gland may be abnormal. The rapid CLA assay has been used with a high degree of success to measure PTH perioperatively in humans undergoing parathyroidectomy for PHP 16–19 . Baseline PTH is measured from a peripheral venous sampling site before surgical excision of the abnormal gland(s) and is compared with PTH concentration 10 minutes after excision of the abnormal gland(s).…”

“…The rapid CLA assay has been used with a high degree of success to measure PTH perioperatively in humans undergoing parathyroidectomy for PHP. [16][17][18][19] Baseline PTH is measured from a peripheral venous sampling site before surgical excision of the abnormal gland(s) and is compared with PTH concentration 10 minutes after excision of the abnormal gland(s). A decrease in PTH 450% between the pre-and postexcision samples is associated with removal of the autonomously functioning parathyroid tissue in people.…”

Current treatments in the management of patients with primary hyperparathyroidism

“…In this test, samples of venous blood are obtained from a peripheral vein for PTH quantification before and 5 and 10 min after surgical excision of pathological parathyroid tissue, by a rapid (10–15 min) PTH assay. A PTH decrement of >50% 10 min after excision of the adenoma is considered a success3 35 50 51 (fig 1). Intraoperative ultrasound can be useful in localising lesions and tumours located in the thyroid capsule.…”