Rapid Intraoperative Parathyroid Hormone Assay in the Surgical Management of Hyperparathyroidism

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Craig M Nelson, PhD, CLS; Noel S Victor, MD

Winter 2007 - Volume 11 Number 1

https://doi.org/10.7812/TPP/04-082

Abstract

Context: Historically, successful surgical management of primary hyperparathyroidism has required bilateral exploration of the neck. By confirming complete removal of hypersecreting tissue, an intraoperative parathyroid hormone (IO-PTH) assay allows use of a more limited procedure.
Objective: Our objective was to evaluate the utility of IO-PTH assay used in 32 parathyroid explorations versus conventional bilateral exploration used before the advent of IO-PTH assays.
Methods: Minimally invasive parathyroidectomy (MIP) was used. Plasma samples were obtained at several intervals and were analyzed for IO-PTH by use of a rapid immunochemiluminescent assay (ICMA). Outcomes were assessed by univariate inferential testing, yielding one-tailed t-test results.
Results: The study group had a mean plasma IO-PTH level decrease of 87% at ten minutes after excision. All 32 patients who underwent MIP using IO-PTH monitoring had successful surgery. At last postoperative follow-up examination, all 32 patients were normocalcemic. There were statistically significant decreases in duration of surgery, length of hospital stay, and surgery cost.
Conclusions: IO-PTH levels predicted the postoperative outcome for all patients studied, can provide valuable information to surgeons, and can decrease the duration of surgery and hospital stay.