Intraoperative Testing for Parathyroid Hormone: A Comprehensive Review of the Use of the Assay and the Relevant Literature

Abstract

Objective.—The rapid intraoperative parathyroid hormone assay is transforming the parathyroidectomy procedure. We present a review of the literature on the use of the assay as an adjunct to surgery. To our knowledge, this is the first review of the literature to encompass and compare all known primary studies of this assay in parathyroidectomy patients. Data Sources.—Articles were collected by searching MEDLINE databases using relevant terminology. The references of these articles were reviewed for additional studies. Supplementary articles pertinent to the parathyroidectomy procedure, preoperative parathyroid localization studies, and intraoperative parathyroid hormone assay development also were examined. Study Selection and Data Extraction.—One hundred sixty-five references were analyzed and categorized separately into groups. Data Synthesis.—The primary studies of intraoperative data on patients undergoing parathyroidectomy were compared when possible. Studies were analyzed by type of assay used, where performed, turnaround time, and efficiency of use. Reviews of the types of parathyroid surgery and preoperative localization were included for educational purposes. Conclusions.—The intraoperative parathyroid hormone assay is a useful adjunct to preoperative imaging and parathyroid surgery because of its unique ability to detect an occult residuum of hyperfunctioning parathyroid tissue. Use of this assay will obviate the need for frozen section in most routine cases. The test facilitates minimally invasive parathyroidectomy for single parathyroid adenomas, which, in turn, improves cost-effectiveness and cosmetic outcome. Its use in patients with known preoperative multiglandular disease is promising but requires further study.

Successful minimally invasive surgery for primary hyperparathyroidism: influence of preoperative imaging and intraoperative parathyroid hormone levels

“…Intraoperative levels of parathormone measured the 1-84 iPTH using a two-step sandwich solid-phase enzyme immunoassay (ARCHITECT © iPTH assay, Abbott Diagnostic Division, USA). The 1-84 iPTH half-life ranges between 4 and 5 min [23][24][25][26][27][28]. The iPTH is independent of the glomerular filtration rate and represents the biologically active hormone part [29].…”

Use of intraoperative parathyroid hormone measurements during parathyroidectomy to predict postoperative parathyroid hormone levels in patients with renal hyperparathyroidism: meta-analysis

“…In patients with sporadic primary HPT the half-life of PTH is approximately 3 min 64 . In a review including 19 studies studying patients with single-gland HPT, a 75 per cent decrease of ioPTH was observed 10 min after resection in all studies and ioPTH seemed to plateau thereafter 65 . Future studies should assess whether PTH kinetics in those with a functioning kidney transplant behave similarly to those with sporadic primary HPT.…”

Clinical Biomarkers in Otolaryngology—Head and Neck Surgery

“…[65][66][67] This is the assay most commonly used currently and is the "intact" PTH test ordered at most facilities and can be run quickly, on the order of 10-30 minutes. [64][65][66][67] Intraoperative PTH testing has been used to confirm successful management of hyperparathyroidism due to adenoma or cancer, to demonstrate existence of multi-glandular disease, or identify existence of ectopic glands. 64,68,69…”