Is intraoperative parathyroid hormone monitoring necessary with ipsilateral parathyroid gland visualization during anticipated unilateral exploration for primary hyperparathyroidism: A two-institution analysis of more than 2,000 patients

Mohammad H. Rajaei, Sarah C. Oltmann, Cameron D. Adkisson, Dawn M. Elfenbein, Herbert Chen, Sally E. Carty, Kelly L. McCoy

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11 Citations (Scopus)

Abstract

Introduction Intraoperative parathyroid hormone (ioPTH) monitoring during focused parathyroidectomy for primary hyperparathyroidism (PHPT) is used commonly, but some argue that ioPTH adds little if a normal ipsilateral parathyroid gland (IPG) is visualized. This hypothesis was tested for validity. Methods The prospective databases of consecutive patients with PHPT undergoing initial parathyroidectomy with ioPTH at two academic institutions were queried. Patients with ectopic adenoma, familial PHPT, previous parathyroidectomy, planned bilateral exploration, or <6 months follow-up were excluded. Persistence was defined as hypercalcemia at <6 months. Results From 1998 to 2013, 2,162 patients met inclusion criteria, and the rate of persistent disease was 1.5%. Most (n = 1,353; 63.5%) underwent single-gland resection with ioPTH and no IPG visualization, with 1% persistence. Among patients with a single adenoma resected and a normal IPG visualized, 15.2% had contralateral disease. Resection based on IPG appearance alone would have resulted in 13% persistent disease. Conclusion In PHPT, the cure rate for initial unilateral exploration guided by ioPTH is 98.5% versus a predicted rate of 87% when decision making is based on IPG appearance alone. Routine visualization of IPG is not necessary during exploration for suspected single adenoma guided by ioPTH. ioPTH remains useful in optimizing outcomes.

Original languageEnglish (US)
Article number3852
Pages (from-to)760-768
Number of pages9
JournalSurgery (United States)
Volume156
Issue number4
DOIs
StatePublished - Oct 1 2014

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Parathyroid Glands
Primary Hyperparathyroidism
Parathyroid Hormone
Parathyroidectomy
Adenoma
Hypercalcemia
Decision Making
Databases

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

Cite this

Is intraoperative parathyroid hormone monitoring necessary with ipsilateral parathyroid gland visualization during anticipated unilateral exploration for primary hyperparathyroidism : A two-institution analysis of more than 2,000 patients. / Rajaei, Mohammad H.; Oltmann, Sarah C.; Adkisson, Cameron D.; Elfenbein, Dawn M.; Chen, Herbert; Carty, Sally E.; McCoy, Kelly L.

In: Surgery (United States), Vol. 156, No. 4, 3852, 01.10.2014, p. 760-768.

Research output: Contribution to journalArticle

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abstract = "Introduction Intraoperative parathyroid hormone (ioPTH) monitoring during focused parathyroidectomy for primary hyperparathyroidism (PHPT) is used commonly, but some argue that ioPTH adds little if a normal ipsilateral parathyroid gland (IPG) is visualized. This hypothesis was tested for validity. Methods The prospective databases of consecutive patients with PHPT undergoing initial parathyroidectomy with ioPTH at two academic institutions were queried. Patients with ectopic adenoma, familial PHPT, previous parathyroidectomy, planned bilateral exploration, or <6 months follow-up were excluded. Persistence was defined as hypercalcemia at <6 months. Results From 1998 to 2013, 2,162 patients met inclusion criteria, and the rate of persistent disease was 1.5{\%}. Most (n = 1,353; 63.5{\%}) underwent single-gland resection with ioPTH and no IPG visualization, with 1{\%} persistence. Among patients with a single adenoma resected and a normal IPG visualized, 15.2{\%} had contralateral disease. Resection based on IPG appearance alone would have resulted in 13{\%} persistent disease. Conclusion In PHPT, the cure rate for initial unilateral exploration guided by ioPTH is 98.5{\%} versus a predicted rate of 87{\%} when decision making is based on IPG appearance alone. Routine visualization of IPG is not necessary during exploration for suspected single adenoma guided by ioPTH. ioPTH remains useful in optimizing outcomes.",
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N2 - Introduction Intraoperative parathyroid hormone (ioPTH) monitoring during focused parathyroidectomy for primary hyperparathyroidism (PHPT) is used commonly, but some argue that ioPTH adds little if a normal ipsilateral parathyroid gland (IPG) is visualized. This hypothesis was tested for validity. Methods The prospective databases of consecutive patients with PHPT undergoing initial parathyroidectomy with ioPTH at two academic institutions were queried. Patients with ectopic adenoma, familial PHPT, previous parathyroidectomy, planned bilateral exploration, or <6 months follow-up were excluded. Persistence was defined as hypercalcemia at <6 months. Results From 1998 to 2013, 2,162 patients met inclusion criteria, and the rate of persistent disease was 1.5%. Most (n = 1,353; 63.5%) underwent single-gland resection with ioPTH and no IPG visualization, with 1% persistence. Among patients with a single adenoma resected and a normal IPG visualized, 15.2% had contralateral disease. Resection based on IPG appearance alone would have resulted in 13% persistent disease. Conclusion In PHPT, the cure rate for initial unilateral exploration guided by ioPTH is 98.5% versus a predicted rate of 87% when decision making is based on IPG appearance alone. Routine visualization of IPG is not necessary during exploration for suspected single adenoma guided by ioPTH. ioPTH remains useful in optimizing outcomes.

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