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The influence of intraoperative parathyroid hormone monitoring on the surgical management of hyperparathyroidism Mandell DL; Genden EM; Mechanick JI; Bergman DA; Diamond EJ; Urken MLArch Otolaryngol Head Neck Surg 2001[Jul]; 127 (7): 821-7OBJECTIVE: To examine the role of intraoperative rapid parathyroid hormone (PTH) monitoring in the surgical management of hyperparathyroidism. DESIGN: Thirty-eight-month retrospective review. SETTING: Tertiary care academic medical center. PATIENTS: One hundred consecutive patients undergoing surgery for primary hyperparathyroidism. INTERVENTION: All patients underwent preoperative technetium Tc 99m sestamibi scan localization and intraoperative blood PTH monitoring by means of a rapid (12-minute) immunochemiluminometric assay. MAIN OUTCOME MEASURES: The influence of intraoperative PTH levels on extent of surgical dissection and achievement of postoperative normocalcemia. RESULTS: Intraoperative PTH levels dropped an average of 64%, 75%, and 83% at 5, 10, and 20 minutes, respectively, after excision of all hyperfunctioning parathyroid tissue. A PTH decrease of 46% or more at 10 minutes and 59% or more at 20 minutes after excision of hyperfunctioning tissue was predictive of postoperative normocalcemia. In 79 patients (79%), the sestamibi scan provided accurate preoperative localization; all but 1 of these patients were treated successfully, most often with a limited, gland-specific dissection. In 24 patients with inaccurate, negative, or misleading preoperative sestamibi scans, 23 (96%) were treated successfully with the use of the intraoperative PTH assay. CONCLUSIONS: The rapid intraoperative PTH assay accurately predicts postoperative success in patients with primary hyperparathyroidism. The rapid PTH assay allows for greater confidence in performing limited dissections in well-localized uniglandular disease. In cases of inaccurate preoperative localization, the rapid PTH assay directly affects surgical decision making and provides greater confidence in determining when surgical success has been achieved.|*Monitoring, Intraoperative[MESH]|*Parathyroidectomy[MESH]|Adult[MESH]|Aged[MESH]|Aged, 80 and over[MESH]|Calcium/blood[MESH]|Female[MESH]|Humans[MESH]|Hyperparathyroidism/blood/diagnostic imaging/*surgery[MESH]|Male[MESH]|Middle Aged[MESH]|Parathyroid Hormone/*blood[MESH]|Postoperative Complications/blood[MESH]|Predictive Value of Tests[MESH]|Radionuclide Imaging[MESH]|Recurrence[MESH]|Reoperation[MESH]|Retrospective Studies[MESH]|Technetium Tc 99m Sestamibi[MESH]|Treatment Outcome[MESH] |
