Surgical Management of Primary Hyperparathyroidism

Mozzon, Marta; Mortier, Pierre-E.; Jacob, Paul; Soudan, Benoı̂t; Boersma, A Arnold; Proye, C

doi:10.1097/01.sla.0000145927.29265.8a

Cited by 27 publications

(4 citation statements)

References 21 publications

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“…Additionally, in 38.5% of the cases who were converted to bilateral exploration in their study, conversion was unnecessary, since no additional pathologic gland was found. Similar findings with concordant imaging were described by several other groups [14][15][16][17]. These findings are currently reflected in the ESES guidelines stating that ioPTH is recommended mainly in cases of discordant or Fig.…”

Section: Discussionsupporting

confidence: 86%

“…However, given the substantial advances in imaging techniques over the years which allow better indication to parathyroid localization, the added value of ioPTH has become questionable. Not surprisingly, a few publications have already demonstrated comparable cure rates of MIP without ioPTH monitoring [13][14][15][16][17]. Indeed, alongside to its advantages, there are some downsides to using ioPTH and these should all be calculated and discussed.…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies questioned the necessity of ioPTH in the management of patients with concordant preoperative imaging. Several authors concluded that ioPTH does not seem to improve the outcome for these patients and other studies advise against ioPTH and recommend adopting the first day postoperative measurement of PTH [13–17]. In addition, ioPTH testing is not completely accurate.…”

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Parathyroidectomy: Can Intraoperative Parathyroid Hormone Monitoring be Omitted?

et al. 2022

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Background Intraoperative PTH (ioPTH) monitoring has become widely accepted in the era of minimally invasive parathyroidectomy (MIP). The purpose of this study was to evaluate the need for ioPTH during parathyroidectomy in patients with positive preoperative imaging. Methods The charts of patients who underwent parathyroidectomy at three tertiary centers between the years 2012 and 2021 were retrospectively reviewed. Patients were defined as MIP candidates with either concordant preoperative imaging or a single positive imaging. Patients with negative or discordant imaging, concomitant thyroidectomy, or previous neck surgery were excluded. Results Of a total of 1013 patients who underwent parathyroidectomy, 535 (52.8%) were defined as MIP candidates and were included in the statistical analysis. Surgical success was achieved in all patients. A single adenoma that corresponded to the preoperative imaging was identified and resected in 517 (93.8%) patients. In only 18 (3.3%) patients, the ioPTH correctly changed the operative management where additional pathologic glands were identified and excised. Patients with additional lesions were significantly more likely to have decreased index adenoma size as indicated either by preoperative imaging or by intraoperative findings (15.5 ± 6.6 vs. 8.3 ± 2.5 mm, p < 0.001). None of the patients with an adenoma size greater than 13 mm had an additional pathologic gland. Conclusions Our findings suggest that the routine use of ioPTH in MIP candidates may be omitted in patients with an index adenoma greater than 13 mm, even with only a single positive preoperative imaging study, without compromising surgical success.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimally Invasive Parathyroidectomy: Can Intraoperative Parathyroid Hormone Monitoring be Omitted?

et al. 2022

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“…18 Failure of PTH levels to fall significantly after excision of a single abnormal parathyroid gland leading to bilateral conversion has been also been reported in a number of other studies. [22][23][24] A study of 119 patients collected PTH results without disclosing these at the time of surgery.…”

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confidence: 99%

The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery

Helbrow

Owais

Sidwell

et al. 2016

annals

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INTRODUCTION Surgery is the first-line management option for patients with primary hyperparathyroidism (pHPT). Minimally invasive parathyroidectomy (MIP) is now preferable but few centres offer this service, mainly because of lack of intraoperative parathyroid hormone (IOPTH) testing. The aim of this study was to identify whether the measurement of IOPTH in patients having minimally invasive parathyroidectomy for pHPT alters their management. METHODS A retrospective review was carried out of 78 consecutive patients who underwent parathyroid surgery by a single surgeon with a special interest in parathyroid surgery. The clinical impact of IOPTH monitoring was recorded postoperatively in a timely manner. Serum adjusted calcium levels were checked preoperatively (on admission) and one month postoperatively; normalisation was considered a cure. RESULTS In the setting of curative MIP, IOPTH measurement did not influence the management in any of the patients but it could have led to bilateral parathyroid exploration (BPE) in three instances. Similarly, in cases that required lengthening of the MIP incision, IOPTH results did not influence patient management although it could have led to BPE in one case. CONCLUSIONS MIP offers an effective cure for patients with hyperparathyroidism. The addition of IOPTH testing adds increased expense, operating time and risk to patients otherwise suitable for MIP.

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Are Additional Localization Studies and Referral Indicated for Patients With Primary Hyperparathyroidism Who Have Negative Sestamibi Scan Results?

et al. 2010

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Surgical Management of Primary Hyperparathyroidism

Cited by 27 publications

References 21 publications

Minimally Invasive Parathyroidectomy: Can Intraoperative Parathyroid Hormone Monitoring be Omitted?

Minimally Invasive Parathyroidectomy: Can Intraoperative Parathyroid Hormone Monitoring be Omitted?

The use of intraoperative parathyroid hormone monitoring in minimally invasive parathyroid surgery

Are Additional Localization Studies and Referral Indicated for Patients With Primary Hyperparathyroidism Who Have Negative Sestamibi Scan Results?

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