Reoperative Parathyroid Surgery in the Era of Sestamibi Scanning and Intraoperative Parathyroid Hormone Monitoring

Abstract

Hypothesis: Results of reoperative parathyroid surgery (RPS) have improved with the advent of sestamibi parathyroid subtraction scanning and intraoperative parathyroid hormone (IOPTH) monitoring. Design: Retrospective review of patient histories, preoperative localization studies, operative data, including IOPTH monitoring, and outcomes for patients undergoing recent RPS at a single institution. Follow-up was complete (mean, 20 months). Setting: Tertiary care referral center. Patients: All patients undergoing RPS for benign persistent or recurrent primary hyperparathyroidism during the period 1989 to 1997. Main Outcome Measures: Overall cure rate and operative morbidity from RPS; sensitivity and accuracy of preoperative localization studies; and prediction of cure from IOPTH monitoring. Results: The study group included 124 patients (87 women and 37 men). Hypercalcemia was corrected in 109 patients (88%). Permanent recurrent laryngeal nerve in

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

“…Use of preexcision samples has been suggested to reduce the number of false-negative results in patients with a single adenoma (33,42 ). Timing of postexcision samples is generally at 5 and/or 10 min, although timings of 7 and 20 min have been used in reported studies (44,45 ). A recent protocol has suggested that an immediate post-gland excision sample may also be useful (46 ).…”

“…Cure rates of Ͼ95% have been reported in several studies (7,29,32,49,50 ), including one study with up to 5 years of follow-up (51 ). In addition, the rapid PTH assay has been shown to be useful in cases of secondary-tertiary hyperparathyroidism (32,39,52 ), as well as in reoperative cases for failed surgery or recurrent disease (32,45,53,54 ). The assay has also been reported to predict severe postoperative hypocalcemia in reoperative patients with multiglandular disease (55 ).…”

Effect of open minimally invasive parathyroidectomy in the management of primary hyperparathyroidism

“…9 Thompson et al recently reported an 88% cure rate at reoperation, with a 13% rate of Hypocalcemia and a 0.8% incidence of nerve injury. 11 In interpreting reoperative results, we must remember that the hypoparathyroidism is most likely secondary to injury or removal of normal parathyroid glands at the initial procedure rather than to injury to normal glands at reoperation.…”

Radio-Guided Surgery and Intraoperative iPTH Determination in the Treatment of Primary Hyperparathyroidism

“…Nevertheless, Thompson et al (1999) suggested that a cut-off of 70% would result in the identification of a higher proportion of patients with multiglandular disease. On the other hand, Dackiw et al (2000) proposed that, when using the ioPTHi determination in patients with MEN1, it is reasonable to apply the same target used by Clary et al (1997) -an approximately 80% decrease in ioPTHi level-in patients with secondary hyperparathyroidism and parathyroid hyperplasia.…”