Intraoperative calcium monitoring is insufficient to predict the surgical success of parathyroidectomy for primary hyperparathyroidism

Abstract

Individual short-term intraoperative changes of tCa or iCa are not predictive for successful PTX, as they more likely reflect changes in intraoperative fluid management rather than decreased iPTH.

Preoperative 11C‐Methionine PET/CT Enables Focussed Parathyroidectomy in MIBI‐SPECT Negative Parathyroid Adenoma

“…For this reason, the adenoma was transsternally removed during the bypass operation and an iPTH was not analyzed. Successful parathyroidectomy was defined as a more than 50 % decrease of iPTH 10 min after parathyroidectomy (Miami criteria) in the presence of histologically proven parathyroid pathology [9][10][11][12].…”

“…In cases of additional thyroid pathology, thyroidectomy, lobectomy, or subtotal thyroid resection was performed after successful parathyroidectomy. Intraoperative management included frozen sections of the extirpated parathyroid and measurement of the parathyroid hormone (iPTH) as previously described in all but one patient [9]. This patient had to undergo a coronary bypass operation.…”

“…Successful parathyroidectomy was defined as a more than 50 % decrease of iPTH 10 min after parathyroidectomy (Miami criteria) in the presence of histologically proven parathyroid pathology [9–12].…”

Intra-operative serum calcium monitoring compares favourably with parathyroid hormone monitoring to determine completeness of surgery for parathyroid adenoma

“…This is in accord with a previous report by Diaz-Aguirregoitia et al 3 Other authors disagree with this conclusion. 4,5 However, their objection is based on a too early (10 min) post-operative serum calcium measurement when the reduction was still modest (albeit statistically significant in our study) compared to greater reduction at a later 20 min time point. To address this objection to the use of calcium monitoring we suggest that a 20 min serum calcium measurement be used as the cut-off point to determine successful adenoma excision rather than the 10 min cut-off used for PTH monitoring.…”