Role of intraoperative parathyroid hormone in guiding parathyroidectomy

Role of intraoperative parathyroid hormone in guiding parathyroidectomy

Authors

  • Chirag Pereira Royal Lancaster Infirmary

Keywords:

Parathyroid hormone, parathyroidectomy, intra-operative PTH, primary hyperparathyroidism

Abstract

Background and Aim: The aim of the study was to determine the sensitivity, specificity and diagnostic accuracy of intra-operative parathyroid hormone (IOPTH) in patients undergoing surgery for primary hyperparathyroidism based on Miami criteria. Methods: A total of 107 medical records of patients who underwent surgery for primary hyperparathyroidism were reviewed from August 2018 to December 2021. Patients that underwent surgery for recurrent or persistent pHPT were excluded from the study and the following data was analysed: sex, age, pre-operative PTH and 10 minutes post excision PTH levels, type of surgery and histopathological features. Results: There was a greater number of women (79.5%) in the study with a mean age of 65.14 years. The mean preoperative PTH were 17.7 pmol/L while the mean intra-operative PTH following excision was 6.5 pmol/L. The sensitivity, specificity and diagnostic accuracy of intra-operative PTH were 86.14%, 100% and 86.9%, respectively. Conclusion: Intra-operative PTH is a valuable investigation that can guide successful parathyroidectomy.

Author Biography

Chirag Pereira, Royal Lancaster Infirmary

Department of general surgery

References

1.Saleem M, Iftikhar H. Stones, Bones, Groans, and Psychic Moans: Primary Hyperparathyroidism Presenting as Surgical Emergency. Cureus. 2019;11(6):e4989.

Khan AA, Khatun Y, Walker A, Jimeno J, Hubbard JG. Role of intraoperative PTH monitoring and surgical approach in primary hyperparathyroidism. Ann Med Surg (Lond). 2015;4(3):301-305.

Naik AH, Wani MA, Wani KA, Laway BA, Malik AA, Shah ZA. Intraoperative Parathyroid Hormone Monitoring in Guiding Adequate Parathyroidectomy. Indian J Endocrinol Metab. 2018;22(3):410-416.

Thier M, Nordenström E, Bergenfelz A, Westerdahl J. Surgery for patients with primary hyperparathyroidism and negative sestamibi scintigraphy – A feasibility study. Langenbecks Arch Surg 2009;394:881‑4.

Bergenfelz AO, Wallin G, Jansson S, Eriksson H, Mårtensson H, Christiansen P, et al. Results of surgery for sporadic primary hyperparathyroidism in patients with preoperatively negative sestamibi scintigraphy and ultrasound. Langenbecks Arch Surg 2011;396:83‑90.

Cayo AK, Sippel RS, Schaefer S, Chen H. Utility of intraoperative PTH for primary hyperparathyroidism due to multigland disease. Ann Surg Oncol. 2009 Dec;16(12):3450-4.

Chen H, Pruhs Z, Starling JR, Mack E. Intraoperative parathyroid hormone testing improves cure rates in patients undergoing minimally invasive parathyroidectomy. Surgery. 2005 Oct;138(4):583-7; discussion 587-90.

Irvin GL 3rd, Carneiro DM, Solorzano CC. Progress in the operative management of sporadic primary hyperparathyroidism over 34 years. Ann Surg. 2004 May;239(5):704-11.

Irvin GL 3rd, Solorzano CC, Carneiro DM. Quick intraoperative parathyroid hormone assay: surgical adjunct to allow limited parathyroidectomy, improve success rate, and predict outcome. World J Surg. 2004 Dec;28(12):1287-92.

Yu N, Donnan PT, Murphy MJ, Leese GP. Epidemiology of primary hyperparathyroidism in Tayside, Scotland, UK. Clin Endocrinol (Oxf). 2009 Oct;71(4):485-93.

Starker LF, Akerström T, Long WD, Delgado-Verdugo A, Donovan P, Udelsman R, Lifton RP, Carling T. Frequent germ-line mutations of the MEN1, CASR, and HRPT2/CDC73 genes in young patients with clinically non-familial primary hyperparathyroidism. Horm Cancer. 2012 Apr;3(1-2):44-51.

Dobrinja C, Santandrea G, Giacca M, Stenner E, Ruscio M, de Manzini N. Effectiveness of Intraoperative Parathyroid Monitoring (ioPTH) in predicting a multiglandular or malignant parathyroid disease. Int J Surg. 2017;41 Suppl 1:S26-S33.

Duan K, Gomez Hernandez K, Mete O. Clinicopathological correlates of hyperparathyroidism. J Clin Pathol. 2015 Oct;68(10):771-87.

Lumachi F, Zucchetta P, Marzola MC, et al. Advantages of combined technetium-99m-sestamibi scintigraphy and high-resolution ultrasonography in parathyroid localization: comparative study in 91 patients with primary hyperparathyroidism. Eur J Endocrinol. 2000;143(6):755-760.

Paek SH, Kim SJ, Choi JY, Lee KE. Clinical usefulness of intraoperative parathyroid hormone monitoring for primary hyperparathyroidism. Ann Surg Treat Res. 2018;94(2):69-73.

Carneiro DM, Solorzano CC, Nader MC, Ramirez M, Irvin GL 3rd. Comparison of

intraoperative iPTH assay (QPTH) criteria in guiding parathyroidectomy: which criterion is the most accurate? Surgery 2003;134:973-9.

Reiher AE, Schaefer S, Chen H, Sippel RS. Does the final intraoperative PTH level really have to fall into the normal range to signify cure? Ann Surg Oncol. 2012 Jun;19(6):1862-7.

Barczyński M, Gołkowski F, Nawrot I. The current status of intraoperative iPTH assay in surgery for primary hyperparathyroidism. Gland Surg. 2015;4(1):36-43

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Published

24-04-2023

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Section

ORTHOPAEDICS AND SURGERY

How to Cite

1.
Pereira C. Role of intraoperative parathyroid hormone in guiding parathyroidectomy. Acta Biomed [Internet]. 2023 Apr. 24 [cited 2024 Jul. 17];94(2):e2023040. Available from: https://mattioli1885journals.com/index.php/actabiomedica/article/view/13998