The Role of Intraoperative Measurement of Parathyroid Hormone in Parathyroid Surgery

Pellitteri, Phillip K.

doi:10.1159/000149835

Cited by 9 publications

(6 citation statements)

References 146 publications

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“…Our review of our series of eight consecutive patients demonstrated a 100% cure rate in both surgical approaches. This is comparable to data showing that the surgical cure rate after MIP is comparable with CNE (14,15) Our results demonstrate the advantages of IOPTH-guided minimally invasive parathyroidectomy (8).…”

Section: Discussionsupporting

confidence: 88%

Intraoperative Parathyroid Hormone Assessment in Patients with Primary Hyperparathyroidism – One–Year Experience

Greif

Hojski

Crnjac

2021

AMB

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Purpose: We evaluated our one– year experience in the intraoperative measurement of parathyroid hormone (IOPTH) in parathyroid adenoma surgery. We also compared surgical outcome after minimally invasive parathyroidectomy (MIP) and conventional neck exploration (CNE). Methods: Between April 2011 and April 2012, eight consecutive patients with primary hyperparathyroidism (PHP) underwent parathyroidectomy with IOPTH in our institution. Parathyroidectomy was defined as successful when a >50% decrease of IOPTH was observed 10 minutes after resection of the abnormal gland. The second criterion for success was a six month period of postoperative normocalcaemia. Results: We performed four MIPs, two unilateral neck explorations, and two bilateral neck explorations, resulting in a total of seven solitary and one double adenomas. IOPTH level decrease expectations were met in all cases. The average length of surgery for MIP was 31 minutes, and 69 minutes for CNE. All patients were eucalcaemic with normal PTH levels during the 6 month follow–up period. Three patients had postoperative hypocalcaemia after CNE and there were no recurrences 6 months postoperatively. Conclusion: The review of our series of eight consecutive patients with PHP showed a 100% cure rate after employing IOPTH measurement in both surgical approaches. The advantages of MIP are: shorter operating time, better cosmetic results, and a lower incidence of hypocalcaemia.

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Section: Discussionsupporting

confidence: 88%

Intraoperative Parathyroid Hormone Assessment in Patients with Primary Hyperparathyroidism – One–Year Experience

Greif

Hojski

Crnjac

2021

AMB

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“…[ 35 ] Many other studies show results which are consistent with our study. [ 36 37 38 39 40 41 42 ]…”

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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“…Darüber hinaus konnte nachgewiesen werden, dass das Morbiditätsspektrum von Osteoporo se, Knochenschmerz, Nephrolithiasis, ein geschränkter Nierenfunktion, Gastrointes tinalulzera, Pankreatitis, Obstipation, ar terioskleroseassoziierten Affektionen des HerzKreislaufSystems, mnestischen Stö rungen sowie Ermüdbarkeit und Energie verlust durch die erfolgreiche Operation günstig beeinflusst wird [2,18,24,29].…”

Section: Intraoperative Parathormonbestimmung Beim Primären Hyperparaunclassified

“…Nachweis eines von zervikal nicht erreichbaren me diastinal gelegenen NSDFokus, der heute in vielen Fällen durch thorakoskopischen Zugang ohne Sternotomie erreicht und beseitigt werden kann [24]. Gerade beim Rezidiveingriff eines PHPT kommt be züglich der Frage der IOPTHBestim mung das Argument zum Tragen, nach Entfernung des fraglich hyperaktiven Ne benschilddrüsengewebes Sicherheit zu er langen, dass keine weitere Quelle hyper aktiven NSDGewebes vorliegt.…”

Section: > Die Entwicklung Eines Späteren Phpt-rezidivs Kann Nicht Auunclassified

Intraoperative Parathormonbestimmung beim primären Hyperparathyreoidismus

Lorenz

Dralle

2010

Chirurg

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Intraoperative parathyroid hormone measurement (IOPTH) has proved to be an important promoter for focused and minimally invasive parathyroidectomy procedures in primary hyperparathyroidism. IOPTH enables multiglandular disease to be excluded with a high degree of certainty at the time of operation. The choice of the cut-off value for IOPTH as the criterion for success is of utmost importance with respect to the prognosis for operative success (biochemical healing). Advantages and disadvantages of the variety of existing IOPTH success criteria are confusing and their assessment is contradictory. Particularly with respect to cost-benefit aspects the standard application of IOPTH as "biochemical frozen section" even in conventional open parathyroidectomy remains a matter of controversy. This article gives an up-date on current knowledge and provides practical guidelines for clinical use of IOPTH.

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The Role of Intraoperative Measurement of Parathyroid Hormone in Parathyroid Surgery

Cited by 9 publications

References 146 publications

Intraoperative Parathyroid Hormone Assessment in Patients with Primary Hyperparathyroidism – One–Year Experience

Intraoperative Parathyroid Hormone Assessment in Patients with Primary Hyperparathyroidism – One–Year Experience

Intraoperative parathyroid hormone monitoring in guiding adequate parathyroidectomy

Intraoperative Parathormonbestimmung beim primären Hyperparathyreoidismus

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