Intraoperative Parathormone Monitoring Mitigates Age-Related Variability in Targeted Parathyroidectomy for Patients with Primary Hyperparathyroidism

Bishop, Brian E.; Wang, Bo; Parikh, Punam P.; Lew, John I.

doi:10.1245/s10434-015-4843-2

Cited by 5 publications

(2 citation statements)

References 29 publications

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“…Indeed, the Miami criterion has been shown to mitigate the age-related challenges of preoperative diagnosis uncertainty with comparable cure rates between the extremes of age groups. 23 Biochemical profile also had an independently significant effect on IOPTH in our analysis. PHPT has classically been diagnosed with the concurrent elevations of PTH and calcium.…”

Section: Discussionmentioning

confidence: 56%

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Graves

Hwang

McManus

et al. 2021

Surgery

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Background: Reduced creatinine clearance is an indication for surgery in asymptomatic primary hyperparathyroidism, and a significant proportion of patients undergoing parathyroidectomy have chronic kidney disease. The purpose of this study was to evaluate the kinetics of intraoperative parathyroid hormone decline during parathyroidectomy in patients who have chronic kidney disease compared with those with who have normal renal function. Methods: This is a single-center, retrospective study of patients with primary hyperparathyroidism undergoing parathyroidectomy (n ¼ 646). Patients were grouped based on estimated glomerular filtration rate greater than (normal renal function) or less than (chronic kidney disease) 60 mL/min/ 1.73m 2 . All patients had intraoperative parathyroid hormone monitoring and 6-month postoperative serum studies to confirm surgical cure. Intraoperative parathyroid hormone kinetic curves were analyzed using a linear mixed model. Results: Despite similar pre-excision values, patients with chronic kidney disease had significantly higher intraoperative parathyroid hormone values at 5 minutes (76 vs 58 pg/mL, P ¼ .02) and 10 minutes (54 vs 37 pg/mL, P ¼ .004) postexcision. No significant difference was observed in whether patients met Miami criterion by 5 minutes (chronic kidney disease 71%, normal renal function 78%, P ¼ .255) or by 10 minutes (chronic kidney disease 95%, normal renal function 96%, P ¼ .751) postexcision. Using a linear mixed model, glomerular filtration rate did not have a significant effect on the change in intraoperative parathyroid hormone over time. Conclusion:Patients with chronic kidney disease had significantly higher postexcision intraoperative parathyroid hormone levels. However, renal function did not affect the change in intraoperative parathyroid hormone over time, nor did renal function ultimately affect the likelihood of meeting the Miami criterion. Intraoperative parathyroid hormone monitoring remains useful in this population, although additional time points may be needed to observe normalization of values.

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Section: Discussionmentioning

confidence: 56%

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Graves

Hwang

McManus

et al. 2021

Surgery

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“…Within all age groups, IOPTH has been found more accurate and sensitive than USG neck or MIBI scan. [ 43 ]…”

Section: Discussionmentioning

confidence: 99%

Intraoperative parathyroid hormone monitoring in guiding adequate parathyroidectomy

Naik

Wani

et al. 2018

Indian J Endocr Metab

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Background:Parathyroidectomy has been traditionally performed through bilateral neck exploration (BNE). However, with the use of intraoperative parathyroid hormone (IOPTH) assay along with preoperative localization studies, focused parathyroidectomy can be performed with good surgical success rate, multiglandular disease can be predicted, and hence recurrence and surgical failure can be prevented. Furthermore, it predicts eucalcemia in the postoperative period. The aim of this study was to evaluate the usefulness of IOPTH assay in guiding adequate parathyroidectomy in patients of primary hyperparathyroidism.Materials and Methods:Between year 2015 and 2017, 45 patients of primary hyperparathyroidism underwent parathyroidectomy with IOPTH assay employed as an intraoperative tool to guide the surgical procedure. Blood samples were collected: (1) at preincision time, (2) preexcision of gland, (3) 5-min postexcision of gland, and (4) 10-min postexcision of gland. On the basis of the Irvin criterion, an intraoperative PTH drop >50% from the highest either preincision or preexcision level after parathyroid excision was considered a surgical success. Otherwise, BNE was performed and search for other parathyroid glands done.Results:Ten-min postexcision PTH levels dropped >50% in 34 (75.6%) patients. True positive among them were 31 (68.8%), true negative 8 (17.7%), false positive 3 (6.6%), and false negative 3 (6.6%). We performed focused exploration at the outset in 40 (88.9%) patients and bilateral exploration for five patients as guided by preoperative localizing studies. Hence, IOPTH was helpful in guiding further exploration in 8 (17.7%) patients and prevented further exploration in 32 (71.1%) patients and also was able to predict eucalcemia in 97.7% patients at 6 months. Thus, IOPTH was able to obviate or to ask for additional procedure in 88.8% of patients. However, in three (6.6%) patients, IOPTH would guide unnecessary exploration and in equally, that is, three (6.6%) patients may require reoperation for unidentified parathyroids.Conclusion:IOPTH in adjunct with other localizing studies is very helpful for carrying out successful parathyroidectomy in uniglandular disease and predicting postoperative eucalcemia. However, more importantly, its role is valuable in equivocal imaging, in such cases, it prevents unnecessary exploration or helps in adequate parathyroidectomy.

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Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism

Faheem

Sakr

Nabawi

et al. 2020

J Endocrinol Invest

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Intraoperative Parathormone Monitoring Mitigates Age-Related Variability in Targeted Parathyroidectomy for Patients with Primary Hyperparathyroidism

Cited by 5 publications

References 29 publications

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

The effect of chronic kidney disease on intraoperative parathyroid hormone: A linear mixed model analysis

Intraoperative parathyroid hormone monitoring in guiding adequate parathyroidectomy

Influence of common clinical variables on intraoperative parathyroid hormone monitoring during surgery for primary hyperparathyroidism

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