Role of preoperative intact parathyroid hormone levels in predicting the likelihood of multiglandular disease in primary hyperparathyroidism

Background. Minimally invasive parathyroidectomy has become increasingly popular for the treatment of primary hyperparathyroidism, but is not a feasible option for multiglandular disease. It has been suggested that preoperative intact parathyroid hormone (iPTH) levels may predict multiglandular disease. We examined this hypothesis in patients who underwent surgical intervention for primary hyperparathyroidism at Johns Hopkins Medical Institutions. Methods. We retrospectively reviewed 502 consecutive patients with primary hyperparathyroidism who underwent parathyroidectomy. Multivariable logistic regression analysis assessed preoperative iPTH levels as a predictor of multiglandular disease and a positive sestamibi scan, after adjustment for age, sex, and race. Results. Preoperative iPTH levels were not significantly associated with a greater likelihood of multiglandular disease. However, sestamibi scan positivity was significantly more likely in patients with higher preoperative iPTH levels. Conclusion. Preoperative iPTH levels are not helpful in predicting multiglandular disease and should not be used to exclude a minimally invasive parathyroidecotomy for patients with primary hyperparathyroidism.