Intraoperative measurement of parathyroid hormone in hyperparathyroidism

Lorenz, Kerstin; Schneider, Rick; Elwerr, Malik

doi:10.1007/s00104-020-01123-9

Cited by 8 publications

(4 citation statements)

References 56 publications

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“…IOPTH was used in all patients to confirm excision success intraoperatively. Operative success was defined as a > 50% drop 20 min after gland excision, consistent with the Rome protocol [ 25 ]. Inappropriate PTH decay dynamics lead to further exploration and excision of macroscopically suspect gland tissue with subsequent IOPTH measurements.…”

Section: Methodsmentioning

confidence: 99%

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Predictors of adenoma size and location in primary hyperparathyroidism

Filser

Uslar

Weyhe

et al. 2021

Langenbecks Arch Surg

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Purpose In primary hyperparathyroidism (PHPT), intraoperative localization of the parathyroid adenoma can be challenging, especially in cases of negative preoperative imaging. Since a focused unilateral parathyroidectomy has benefits compared to a conventional bilateral neck exploration, the question arises whether adenoma size prediction can facilitate a targeted approach. We investigated whether single parathyroid adenoma size can be estimated using preoperative parathyroid hormone (PTH), calcium, and phosphate in patients with PHPT. Preoperative imaging accuracy was evaluated. Methods The data of 156 patients who underwent curative parathyroidectomy for single adenoma PHPT were analyzed retrospectively. Information obtained included laboratory data, imaging results, intraoperative data, and final pathology. Imaging accuracy was analyzed descriptively. The association between preoperative biochemical markers and adenoma dimensions was investigated using Spearman’s correlation coefficient and multivariable regression modeling. Results Cervical ultrasound correctly predicted adenoma laterality in 95.5%, sestamibi scintigraphy in 80.6%, both had lower true-positive rates for quadrant prediction. Patients with negative imaging results showed higher thyroid volumes than those with positive results. Adenoma volume was positively correlated with preoperative PTH (p < 0.001) and calcium (p < 0.001) and negatively correlated with preoperative phosphate (p = 0.001). Using these preoperative biochemical markers and patient age and BMI, adenoma volume can be significantly predicted using the multivariable regression algorithm. Conclusion Cervical ultrasound is superior to scintigraphy for predicting adenoma location and should be the first-choice imaging method, but both methods may be limited by increased thyroid volume. Large adenomas are more likely with higher PTH, higher calcium, and lower phosphate levels. In cases of undetermined adenoma location, an estimation of adenoma volume via our algorithm could corroborate sonographic volume measurements of the suspected adenoma.

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Section: Methodsmentioning

confidence: 99%

“…Intraoperative PTH (IOPTH) assays are a widely used method for intraoperative adenoma verification with excellent overall operative success rates of 97–99%. The most common criteria require a 50% drop in hormone 10 or 20 min after adenoma excision to confirm operative success [ 25 , 26 ].…”

Section: Introductionmentioning

confidence: 99%

Predictors of adenoma size and location in primary hyperparathyroidism

Filser

Uslar

Weyhe

et al. 2021

Langenbecks Arch Surg

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“…Intraoperatively, quick intact parathormone monitoring was performed 15 min after removal of the suspicious parathyroid gland. An adequate drop of intact parathormone was assumed by a significant drop of PTH to normal values in the range of 10% of the preoperative levels according to the Rome criteria [ 15 ].…”

Section: Methodsmentioning

confidence: 99%

Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery

Hendricks

Lenschow

Kroiß

et al. 2021

Langenbecks Arch Surg

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Purpose Repeat surgery in patients with primary hyperparathyroidism (pHPT) is associated with an increased risk of complications and failure. This stresses the need for optimized strategies to accurately localize a parathyroid adenoma before repeat surgery is performed. However, evidence on the extent of required diagnostics for a structured approach is sparse. Methods A retrospective single-center evaluation of 28 patients with an indication for surgery due to pHPT and previous thyroid or parathyroid surgery was performed. Diagnostic workup, surgical approach, and outcome in terms of complications and successful removement of parathyroid adenoma with biochemical cure were evaluated. Results Neck ultrasound, sestamibi scintigraphy, C11-methionine PET-CT, and selective parathyroid hormone venous sampling, but not MRI imaging, effectively detected the presence of a parathyroid adenoma with high positive predictive values. Biochemical cure was revealed by normalization of calcium and parathormone levels 24–48h after surgery and was achieved in 26/28 patients (92.9%) with an overall low rate of complications. Concordant localization by at least two diagnostic modalities enabled focused surgery with success rates of 100%, whereas inconclusive localization significantly increased the rate of bilateral explorations and significantly reduced the rate of biochemical cure to 80%. Conclusion These findings suggest that two concordant diagnostic modalities are sufficient to accurately localize parathyroid adenoma before repeat surgery for pHPT. In cases of poor localization, extended diagnostic procedures are warranted to enhance surgical success rates. We suggest an algorithm for better orientation when repeat surgery is intended in patients with pHPT.

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“…Due to the difficulty in predicting which patients will develop postoperative hypocalcemia, some authors, based on the operation and in serum calcium values, have shown a correlation between hypocalcemia and the drop in PTH in the immediate postoperative period, with statistically significant results (Covic et al, 2020;Kritmetapak & Pongchaiyakul, 2019;K Lorenz, Schneider, & Elwerr, 2020;Mak et al, 2020;S. D. Tsai et al, 2019).…”

Section: Hyperparathyroidismmentioning

confidence: 99%

Post-thyroidectomy hypocalcemia and related complications

Al-Roubaie

2022

ijhs

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The incidence of post-thyroidectomy hypocalcemia is high while the factors involved include age (> 50 years), type of operation, operative time, neck dissection, histology of the surgical specimen and vocal fold paralysis. Low ionic calcium concentrations are indicative of the presence of symptoms of hypocalcemia and the need for oral calcium. Progression to definitive hypoparathyroidism occurs only in patients with clinical manifestations of post-thyroidectomy hypocalcemia. In general, the problem with post-surgical hypoparathyroidism resides in the surgical procedure itself. The most common are related to neuronal hyperexcitability, which explains the paresthesias, cramps and numbness, which usually start in the perioral region and on the fingertips. Muscle spasms and muscle stiffness are also common. When severe, hypocalcemia can lead to life-threatening spastic tetany, laryngospasm, and seizures. The current manuscript aimed to present a review of the bibliography on thyroidectomy and negative impact of its complications on human health, mainly because of a higher risk for developing hypocalcemia. To achieve the study goal, this review covered most recent published articles from 2017 onward.

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Intraoperative measurement of parathyroid hormone in hyperparathyroidism

Cited by 8 publications

References 56 publications

Predictors of adenoma size and location in primary hyperparathyroidism

Predictors of adenoma size and location in primary hyperparathyroidism

Evaluation of diagnostic efficacy for localization of parathyroid adenoma in patients with primary hyperparathyroidism undergoing repeat surgery

Post-thyroidectomy hypocalcemia and related complications

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