Intraoperative parathyroid hormone monitoring as an adjunct to parathyroidectomy.

Abstract:

BACKGROUND:Parathyroidectomy has a success rate of greater than 95% in the hands of experienced surgeons. To maintain this result in a more cost-effective way, intraoperative monitoring of intact parathyroid hormone (iPTH) has been used to decrease operative times. This technique signals when all hyperfunctioning tissue has been excised or when further dissection is necessary. METHODS:Eighty-nine consecutive patients with hyperparathyroidism had plasma samples measured for iPTH levels during parathyroidectomy. Nine patients had previous neck explorations. Perioperative iPTH measurements using immunochemiluminescent assays with a turnaround time of 10 minutes were done after excision of each suspected abnormal parathyroid gland. RESULTS:All patients except one returned to and maintained normal calcium levels during the follow-up period of 8 months (range, 1 to 25 months). Prediction of postoperative calcium levels by means of quick immunochemiluminescent assay has a sensitivity of 97%, specificity of 100%, and an overall accuracy of 97%. Specific influence on surgical judgment was noted in four patients with multiglandular disease, in seven with difficult localization problems, and in one patient in whom the hyperfunctioning parathyroid tissue was not recognized. Monitoring the plasma iPTH levels during parathyroidectomy directly aided the surgeon's operative approach in these 12 patients. CONCLUSIONS:Intraoperative iPTH assay is useful with predictive accuracy of 97%. It influenced or changed the operative approach in 13% of patients.

journal_name

Surgery

journal_title

Surgery

authors

Boggs JE,Irvin GL 3rd,Molinari AS,Deriso GT

doi

10.1016/s0039-6060(96)80040-7

subject

Has Abstract

pub_date

1996-12-01 00:00:00

pages

954-8

issue

6

eissn

0039-6060

issn

1532-7361

pii

S0039-6060(96)80040-7

journal_volume

120

pub_type

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