Preoperative Localization and Intraoperative Parathyroid Hormone Assay in Korean Patients with Primary Hyperparathyroidism

Abstract

BackgroundThe intraoperative parathyroid hormone (IOPTH) assay is widely used in patients with primary hyperparathyroidism (PHPT). We investigated the usefulness of the IOPTH assay in Korean patients with PHPT.MethodsWe retrospectively reviewed the data of 33 patients with PHPT who underwent parathyroidectomy. Neck ultrasonography (US) and 99mTc-sestamibi scintigraphy (MIBI scan) were performed preoperatively and IOPTH assays were conducted.ResultsThe sensitivity of neck US and MIBI scans were 91% and 94%, respectively. A 50% decrease in parathyroid hormone (PTH) levels 10 minutes after excision of the parathyroid gland was obtained in 91% (30/33) of patients and operative success was achieved in 97% (32/33) of patients. The IOPTH assay was 91% true-positive, 3% true-negative, 0% false-positive, and 6% false-negative. The overall accuracy of the IOPTH assay was 94%. In five cases with discordant neck US and MIBI scan results, a sufficient decrease in IOPTH levels helped the surgeon confirm the complete excision of the parathyroid gland with no additional neck exploration.ConclusionThe IOPTH assay is an accurate tool for localizing hyperfunctioning parathyroid glands and is helpful for evaluating cases with discordant neck US and MIBI scan results.

The coexistence of primary hyperparathyroidism and thyroid nodules: should the preoperative work-up of the parathyroid and the thyroid diseases be specifically adjusted?

“…Anyway the i.o. PTH, in spite of the cost increase (44), if used with the aim to assure the completeness of parathyroid excision proved to be an efficacious tool for improving the success rate of surgery, likewise the treatment of the solitary PHPT, as commonly affirmed (45).…”

Minimally Invasive Parathyroidectomy for Primary Hyperparathyroidism

“…The combination of US and MIBI scan is used for diagnosing the abnormal glands preoperatively with 91% and 94% sensitivity rates, respectively (22). We have diagnosed 34 patients with the combined technique and 11 patients with US only.…”

“…Beside even 4D computerized did not provide an improvement in initial cure rate at the surgical treatment of PHPT patients (11). Selective venous sampling is accepted as a successful localization technique for the pathological parathyroid gland, but it is debated for being an invasive technique (12). US, magnetic resonance imaging and MIBI scan are the most applied imaging techniques for pathological parathyroid glands.…”

Articles in 'Endocrinology and Metabolism' in 2014

“…An article entitled "Testosterone deficiency associated with poor glycemic control in Korean male diabetics" explored the relationship between testosterone deficiency and the levels of diabetes markers [ 38 ]. Other original articles on pituitary, adrenal, parathyroid, and pancreatic diseases appeared in 2014 issues [ 39 , 40 , 41 , 42 , 43 ].…”